Box 367, 128 Gladys Street

Elm Creek, MB, R0G 0N0

Tel: (204) 436-3181

Fax: (204) 436-3373

Toll Free: 1-866-680-6393

 

MFWD FARM SAFETY SEMINAR & CONFERENCE

REGISTRATION FORM

This event is put on in partnership with Manitoba Agricultural, Food and Rural Initiatives and Manitoba Community Services Council Inc.

Indicate your choice by selecting 1 box:

FARM SAFETY SEMINAR                                                 MFWD SEMINAR & CONFERENCE

(Friday, March 5, from 9 am to 3 pm)                             (Friday and Saturday, March 5 & 6)        

Registration Fee of $10-lunch incl.                                      Registration $15 for Membership

 

 Name:       Spouse's Name:

Address:         City:

 

Province:       Postal Code: 

 

Phone:                                     Cell:                                         Email:                

          

 

I require child care for: (number of children)

 

Child's Name:     Age:         Child's Name:     Age:         

Child's Name:     Age:         Child's Name:     Age:

 

Total Number of people attending:      

 

Please indicate the meals you will be needing:

I (we) require the following meals. Please place the number of people for each meal.

 

Friday, March 5 Farm Safety Seminar:     Lunch:  

 

MFWD Seminar & Conference:

Friday, March 5:        Lunch:         Supper: 

  

Saturday, March 6:   Lunch:         Supper:  

 

Provide information on any food allergies.