Registration Form (Please print)

Name: __________________________________

Partner's Name:___________________________

Address:_________________________________

City/Town:_______________________________

Province:_______ Postal Code: ______________

Telephone:_______________________________

Fax: ____________________________________

Email:___________________________________

Number of Conferences Previously Attended:____

Most Recent Year:_________________________

How did you learn about this conference?

________________________________________

We were referred by ______________________*


* There will be a referral draw at the conference.
Please indicate if there are any dietary concerns:
________________________________________


Please enclose cheque or money order for registration of $175 if paid before November 30th 2008, or $195 after that, made payable to:

The Banff Couples Conference Society
5 Galaxy Place
St. Albert , AB
T8N 1Z6

Please book hotel accommodations directly with the hotel. Couples must stay at the Delta Lodge at Kananaskis in order to attend the conference.

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