Saskatchewan Brain Injury Association
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Fall Retreat Registration
Register Online:
Please make sure that you fill out all fields that apply.

Name:
Email Address:
Confirm Email Address:
Phone:
Chapter:
Address:
City:
Province:
Postal Code:
Special Dietary Needs:
Family Member or Roomate Staying with you:
Name of Emergency Contact:
Emergency Contact Phone Number:
If you have any mobility and/or other special needs please specify below :
Registration Fees:
Please pay registration fee by mailing a cheque or paying online:
(if cost is a problem, please contact us)

NOT in HOTEL
$50 per person for Members
$60 per person for Non-Members

STAYING at HOTEL
$75 per person for Members
$85 per person for Non-Members

Note: Rooms are limited and only available to people who live outside of Regina. Fees are non-refundable.

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
Canada

Pay online using the form below.