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Please join us on Thursday December 3rd from 6:00pm – 8:30pm at the Shadbolt Centre for the Arts for an evening of appreciation and connection. Complete your registration below to confirm your attendance for the Celebration of Community Impact in Vancouver.

First Name

Last Name

Email Address

What is your preferred language of communication?

EnglishFrench

Communications:

Yes, I would like to receive communications about the impact of my support and updates on MS Canada Yes, I would like to receive SMS communications about the updates from MS Canada

Mobile phone number:

Will you be attending the event?

YesNo

Will you be bringing a guest?

YesNo

Guest First Name

Guest Last Name

Guest Email Address

Please enter your guests emails address, we will contact them to complete their registration.

If applicable, please list any dietary or accessibility needs:

* I consent to use of my personal info by MS Canada for purposes outlined in our privacy statement.

* I acknowledge that I understand the intent thereof, and I hereby agree to absolve and hold harmless the MS Canada, corporate sponsors, co-operating organizations and any other parties connected in any way, singly or collectively (the "Parties”), from and against any blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained as a result of my involvement with MS Canada as an event participant except where such claims are solely caused by the Parties negligence or willful misconduct.

* I give full permission for use of my name, any photographs or videotape images of me taken in the course of my involvement and I understand that it may be used for publications such as MS Canada annual reports, newsletters and online.