reg@pemmi-con.ca

First responders Membership

Please enter information on the form below to process your membership for First responders.

Show on members list

Username*

Password*

Retype Password *

First Name

Last Name *

Badge name

Name on your badge (if not first+last name)

Organization

Address *

Address2

Email *

An e-mail address is necessary for all account management.

City *

Postal or zip code *

Country *

Region *

Province/State/County/etc.

Phone

Membership lists

You may publish my name on these member lists: *

Web list only

Paper list only

Both web and paper

Nowhere

Publish my name as

Name to display, if not first name+last name

I am interested in (check all that apply)

Being a programme participant

Displaying in the Art Show

Being a vendor in the dealer's room

Volunteering with the convention

Masquerade participant or staff

Volunteer for

(a specific area if any)

Subcategory

I wish to receive paper publications

Yes

(everyone will receive digital publications)

Comments regarding registration

Accessibility issues

Any accessibility issues we should be aware of or to arrange for

Payor name

Person who is paying for this

Payment Information

Coupon

Price

CA$

Discount Amount

CA$

Total Amount

CA$

Payment Method *

Stripe Checkout

Paypal

Offline (Cheque, Money order, Interac, etc.)

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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