Please fill in the following information and then click "Submit". The deadline to register by is March 9, 2012.

Note that there is NO registration fee for the conference.  If you would like to attend the banquet, tickets are $10 for students and $30 for non-students.  Please indictate below how many tickets you would like and an invoice will be emailed to you or you may pick up your tickets from the GSA office in RIC 118, Mon.-Fri. 12:00 - 4:00pm.

First Name: *

Please enter your first name. For example, "Peggy".

Last Name: *

Please enter your last name. For example, "Sue".

Student ID Number: *

Please enter your 9-digit student number. For example, "123456789".

Phone: *

Please enter your 7-digit phone number, without any spaces or dashes. For example, "8675309".

Email: *

Please enter your email address. For example, "peggy_sue@uregina.ca".

Special Equipment:

Please list any special equipment that you might need as part of your presentation. For example, "table, overhead projector, lamp".

Number of Banquet Tickets Needed: * select...None1 Ticket2 Tickets

Guest Name:

Please enter both the first and last names of any guest accompanying you to the banquet.

Questions / Comments:

Please enter any questions or comments that you might have.

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