LLLC
La Leche League Canada
Communication Skills for Breastfeeding Support Workshop
Registration
Date and Location: April 7, 2017; Ottawa, ON
Please Print Clearly:
Name: __________________________
Credentials (please check all that apply):
? IBCLC ? MD ? RN
? PHN ? RD ? LLLC Leader
? RM ? Other ____________
Employer: _______________________________
Mailing Address: __________________________
________________________________________
Email: __________________________________
(For confirmation of registration)
COST OF WORKSHOP: $65.00
PLEASE NOTE: Payment in FULL is required at time of registration
Cost of workshop: $65.00
Credit Card: ? Visa ? MasterCard
_____________________ _________
Credit Card Number Exp. Date
________________________________
Name on Card (Please print)
________________________________
Signature
Cheques: Please make cheques payable to
La Leche League Canada.
Cheques at the door must be guaranteed by a credit card (will not be charged unless cheque returned NSF)
Please mail with payment to:
La Leche League Canada – CS April
c/o J. Elder, 180 Liverpool St.
Fredericton, NB E3B 4V5
Registration Questions:
adc@lllc.ca or (306) 992-2125
General information:
communicationskills@LLLC.ca
1. On-line registration is the preferred method of registration as it immediately guarantees your spot at the event.
2. Payment in FULL is REQUIRED at time of registration and MUST accompany mailed registrations.
3. Credit cards and cheques are acceptable; a spot will not be “held” in anticipation of payment.
4. If the payment has not been received at National Office five days before the event, a credit card number will be required for entry.
5. It is the participant’s responsibility to ensure payment is received by LLLC. If you have not received a confirmation e-mail within 3 weeks of mailing this form, please contact communicationskills@LLLC.ca to confirm receipt of registration and payment.
6. Cancellations received prior to March 31, 2017 will be subject to a $30.00 administration fee. We cannot accept cancellations after March 31; however, substitutions may be made at no charge.
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