Speakers Corner Registration

Please fill out the form to register for the Resource Fair and Speakers Corner.

First Name (required)

Last Name (required)

Address (required)

Apartment

City (required)

Province

Postal Code

Email (required)

Daytime Telephone (required)

Preferred Contact Method (required)
EmailTelephone

Please indicate which speakers' sessions you wish to attend (check all that apply):
(A) 12:15- 12:55(B) 1:00-1:45(C) 2:00-2:45(D) 3:00-3:45(E) 4:00-4:45(F) 5:00-5:45(G) 6:00-6:45(H) 7:00-7:45

Are you a member of LDA?
YesNo

If you are not a member, do you wish to become a member?
If yes, please add $50 to your payment to cover the annual membership fee.
YesNo

Ticket prices:
Members:
LDA Members receive 2 free passes.
After two tickets, each ticket is $5 each.

Non-members:
Admission for one person: $25.00
Admission for two people: $17.50 each
Admission for three people or more: $15.00 each

Teacher's Special
Adminssion: $15.00 each

How many tickets would you like:

Please indicate your method of payment:
CashChequeMoney OrderVisaMastercard

We do not accept online payments. If you are paying by credit card, we will contact you for payment by phone. If you are paying by cheque or money order, please write it out to:
Learning Disabilities Association of Mississauga, 800-165 Dundas Street West, Mississauga, Ontario L5B 2N6
You can pay by cash at the door. Just bring a prinout of your confirmation email.

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