APACC  National  Aboriginal  Physical  Activity  Conference  2016    April  28th  –  29th,  2016  Mail  this  form  to:  6520  Salish  Drive,  Vancouver,  BC  V6N  2C7  or  email  to:  aboriginalpacc@gmail.com    or  fax  to  604-­‐266-­‐7612    

PLEASE NOTE: APACC members will receive a discounted registration price, and the membership is free

for all Aboriginal people. To become a member please visit www.a-pacc.com

APACC Team Player number (if applicable): *APACC membership number must be included for membership price*

Full Name: First Middle Last Address:

Box / Street City Province Postal Code Phone #: Email: Title: Position/Occupation: Fees: Adult:

Early Bird Registration, Membership Price Early Bird Registration, Non-Membership Price q Full Registration: $350 q Full Registration: $385 q One day Registration: $250 q One day Registration: $275

Youth/Student/Elders:

Early Bird Registration, Membership Price Early Bird Registration, Non-Membership Price q Full Registration: $225 q Full Registration: $245 q One day Registration: $125 q One day Registration: $135

* Early Bird end date March 15th, 2016 Are you currently a student? q Yes – please provide your student number and attach proof of full-time registration Are you a youth under age 18 years of age or younger? q Yes – please provide proof at registration day Are you an Elder or 65 years of age or older? q Yes Group Registration Discount (Subtract 10%) Apply group discount to each registration, when five or more forms are submitted at the same time, from the same society, organization or Aboriginal community. T-Shirts: Pre-ordered t-shirts are $30.00 each. Men’s qSmall qMedium qLarge qXL qXXL Women’s qSmall qMedium qLarge qXL qXXL Please note: Cash or Cheque Payable to: Aboriginal Physical Activity and Cultural Circle. Registrations are refundable by April 14, 2016 with a $25 administrative fee, and after this date there are no refunds. All prices do not include HST as the conference is on reserve (HST # 84220 0685 RC0001). TOTAL FEES $ Total

PLEASE NOTE: This registration form is for the NAPA CONFERENCE ONLY. If you wish to attend the Pre/Post Conference events you MUST fill out the appropriate registration form found on our website.

Thank you.