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Registration form:
Keynote Speaker: Debbie Mason - Ask me about Multiple Sclerosis
Date: 20 November 2024
Time: 2.30 -3.30 pm
Where: BrainTree, 70 Langdons Rd, Papanui
Cost: $10
You can pay with cash or card on the day.
You are able to register yourself and one guest on the same form.
If the form appears not to be working, we are most likely full. Give us a call on 03 366 2857 and we can put you on the waiting list.
If you have registered and are unable to come, then please let us know so someone may have your seat.
Persons name
*
First name
Last name
Cell phone
Email address
You are able to register a maximum of two people on one form. If you are bringing a guest, please include their name in this space:
Please write the name of your guest in line provided.
Please leave the "1" in the box for yourself or write in a "2" for yourself and a guest, in the box provided
*
Please leave the "1" in the box for yourself or write in a "2" for yourself and a guest, in the box provided
Keynote Deborah Mason
Do you have a question about Multiple Sclerosis?
What is the one question about Multiple Sclerosis you would like to ask Debbie?
My question is:
Please check the highlighted fields
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