Mail Registration Form

May 28, 2011

Leadership Convention
British Columbia Conservative Party
Sheraton Vancouver Guildford Hotel
15269 - 104th Avenue, Surrey, BC

Standard Fee $65 or Early Bird Fee $50

Early Bird Registration discount applies if registration and fees are received on or before

April 20. All registrations received after April 20 will be at the standard fee.

This meeting is open to all Party members. Non-members may also attend (as non-participants)
with a standard fee of $100 or an early bird fee of $80.

Name _________________________________________________

Member ? Yes _____ No _____ # if known ___________ Amt $________

Method of Payment: Visa/MC ________________________ Exp _____________

Name on credit card ________________________________

Signature_____________________________ or Pay by Cheque ____

Street Address ____________________________

City _______________________ Prov. ___________ Postal Code____________

Mailing Address if different from above _________________________________

Phone Number ___________________ Email _____________________________

Return by mail to: Christy Lovig, Chair

Registration
Leadership Convention Committee
C/O DOAK SHIRREFF LLP LAWYERS
200-537 Leon Avenue
Kelowna, BC V1Y 2A9
If paying by cheque make payable to: BC Conservative Party