Listening to the Land

General 1

First Name *

Last Name *

Email *

City

Country

Province

Postal Code *

Event Fee(s) *

Registration Fee - $ 340.00

Registration Fee (Seniors, Students, Low-income) - $ 150.00

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

About you Please feel free to share a bit about yourself. Is there anything about your background or identity that you would like the facilitator to know?

Answer:

Do you have any accessibility needs, physical constraints, medical or mental health concerns? Is there anything that could make the process more easeful for you?

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Feel free to share any additional information/wishes:

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