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Please fill out the following form.

Name *
E-mail Address *
Address *
Church or Agency Information ( if applicable)
I work/volunteer at ( name of agency)
I work/volunteer at (name of agency)
Registration Fee ( includes lunch) *	$60 Late, lunch not gauranteed (Oct 13-18) $25 Student and Senior (aged 60+) I want to apply for a low-income bursary
Briefly explain your situation
	I am adding $ (indicate below) to my payment to help underwrite bursaries for low-income participants

	I'm a church leader or nonprofit executive and will attend the Friday Afternoon Session (free with conference registration; $10 at door without)
Please make my lunch *	Vegetarian Non-vegetarian
	I will attend the Optional Saturday Dinner; please add $20 to my bill. MUST REGISTER BY WEDNESDAY THE 15TH. A LIMITED NUMBER MAY BE AVAILABLE AFTER THIS - ASK AT REGISTRATION TABLE.
Please make my optional Saturday dinner	Vegetarian Non-vegetarian
	Cheque is in the mail ( payable to City in Focus, " housing conference" on memo line)
	Please phone me to for credit card payment
Daytime phone number
Evening phone number
	I will phone City in Focus 604.687.7292 to arrange credit card payment

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CONTACT INFORMATION

Hannah Lee | City In Focus | 1700 -1185 West Georgia St, Vancouver, BC V6E 4E6

Tel 604.687.7292 | Fax 604.484.0058 | hannah@cityinfocus.ca