NLMA Forms
Safe Harbour Registration Form

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Instructions Use this form to register for Safe Harbour.

Registrant

Name*

NLMA Number

Badge Name*

Badge Title

Meal Preference

Cod Steak Vegetarian

Diet/Allergies

Registration

Registrant registration includes all workshops, nutrition breaks, lunches, and dinner for one (1) adult.

Guest 1

Badge Name

Meal Preference

Cod Steak Vegetarian

Diet/Allergies

Registration
(Check all that apply)

Workshops (Adults ONLY; includes lunch and nutrition break)
Leading Your Best Life: A Coach-Based Approach to Resiliency, Clarity and Joy - $100.00
The Science of Longevity and Living Well - $100.00
Mapping Your Own Blue Zone - $100.00
The Happy Life Plan: An Achievable Goal or Lofty Ambition? - $100.00

Lunches (Adults ONLY)
Adult Set Menu (September 30) - $35.00
Adult Set Menu (October 1) - $35.00

Dinner (Adults and children; two sittings, young children encouraged to attend the earlier)
Adult Set Menu (September 30) - $80.00
Child Under 16 Set Menu (September 30) - $45.00
Children's Menu (September 30) - $26.50

Guest 2

Badge Name

Meal Preference

Cod Steak Vegetarian

Diet/Allergies

Registration
(Check all that apply)

Workshops (Adults ONLY; includes lunch and nutrition break)
Leading Your Best Life: A Coach-Based Approach to Resiliency, Clarity and Joy - $100.00
The Science of Longevity and Living Well - $100.00
Mapping Your Own Blue Zone - $100.00
The Happy Life Plan: An Achievable Goal or Lofty Ambition? - $100.00

Lunches (Adults ONLY)
Adult Set Menu (September 30) - $35.00
Adult Set Menu (October 1) - $35.00

Dinner (Adults and children; two sittings, young children encouraged to attend the earlier)
Adult Set Menu (September 30) - $80.00
Child Under 16 Set Menu (September 30) - $45.00
Children's Menu (September 30) - $26.50

Guest 3

Badge Name

Meal Preference

Cod Steak Vegetarian

Diet/Allergies

Registration
(Check all that apply)

Workshops (Adults ONLY; includes lunch and nutrition break)
Leading Your Best Life: A Coach-Based Approach to Resiliency, Clarity and Joy - $100.00
The Science of Longevity and Living Well - $100.00
Mapping Your Own Blue Zone - $100.00
The Happy Life Plan: An Achievable Goal or Lofty Ambition? - $100.00

Lunches (Adults ONLY)
Adult Set Menu (September 30) - $35.00
Adult Set Menu (October 1) - $35.00

Dinner (Adults and children; two sittings, young children encouraged to attend the earlier)
Adult Set Menu (September 30) - $80.00
Child Under 16 Set Menu (September 30) - $45.00
Children's Menu (September 30) - $26.50

Notes

Requests/Questions


(*required)

Policies
Deadline Registration closes 5 pm, Friday, September 15.
NLMA Cancelation
The NLMA reserves the right to cancel this event due to insufficient registration or circumstances beyond our control; registrants will be notified and provided a full refund. The NLMA is not responsible for any non-refundable costs, including, but not limited to, airline or accommodation costs.
Registrant Cancelation Cancellations received by 5 pm, September 15, 2017 will receive a full refund of the registration fee, less a $50 cancellation fee. Cancellations received after 5 pm, September 15, 2017 will be charged a $250 cancellation fee.


Assistance For assistance, please contact Robyn Pike, Communications Coordinator at (709) 726-7424 (314), (800) 563-2003 (314) or rpike@nlma.nl.ca.

Newfoundland and Labrador Medical Association
164A MacDonald Dr., St. John's, NL, Canada, A1A 4B3
Telephone (709) 726-7424 | Toll Free (800) 563-2003 | Fax (709) 726-7525
E-mail nlma@nlma.nl.ca | Web www.nlma.nl.ca