Northern Council 2015 Conseil du nord

Sault Ste Marie Delta Waterfront May 29-31 / le 29 31 mai

Delegate Registration ~ Inscription des dlgues
Name \ nom : _________________________________________________________________
Address \ addresse : ___________________________________________________________
City \ ville: _________________________________ Postal Code \ code postale: _________
Email \ courriel: _______________________________________________________________
Phone \ tel: _____________________ Riding \ circonscription: ______________________
Union affiliation \ syndicat: ____________________________________________________
[___] I am a member of the NDP living in Northern Ontario

Je suis un membre du NPD qui habite en Nord de lOntario

OR / ou
[___] I am a member of the NDP and wish to observe Northern Council

Je suis un membre du NPD et je veux lobserver le conseil du Nord

Delegate Fee / frais dinscription

Choose one / choisir un:

[___]

$110 Early Bird (to May 15) \ inscription anticipe (jusqua le 15 mai)

[___]

$130 Regular fee \ prix rgulier

[___]

$60 Youth fee (up to age 26) \ dlgue jeune (jusqua lage 26 ans)

Pay by cheque or money order to NDP Northern Council

Paiment par cheque ou mandat fait a lordre du NDP Northern Council

Mail to \ lenvoyer : NDP Northern Council 2015 Conseil du Nord NPD
182 George Ave Lively ON P3Y 1M9

ONLINE REGISTRATION NOW AVAILABLE \ inscrivez-vous enligne :

www.tinyurl.com/ndpnc2015