Please make sure that you fill out all fields that apply.
Family Member(s) Staying with you:
Name of Emergency / Primary Contact:
Emergency Contact Phone Number:
If you have any mobility and/or other special needs please specify below :
The Health Form is also required for registration, but is not available online due to privacy laws. Please download and submit the health form, either by email to firstname.lastname@example.org or by mail to P.O. Box 3843 Regina SK S4P 3Y3.
$45 for a member
$55 for member
$180 per family
Please make checks payable to the Saskatchewan Brain Injury Association and mail to:
Saskatchewan Brain Injury Association
P.O. Box 3843
Regina, SK S4P 3Y3
Pay online using the form below.