Learning Disabilities Association within Peel Region (North Peel)

Name (required)

Address (required)

Address (required)

City (required)

Email (required)

Daytime Telephone (required)

Preferred Contact Method (required)
 Email Telephone

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) 5:00-6:00 (G) 6:15-7:00 (H) 7:00-7:45

Are you a member of LDA?
 Yes No

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.
 Yes No

Ticket prices:
Members:
LDA Members receive 1 complimentary pass for two people .
After two tickets, non-member prices apply.

Non-members:
Admission for one person is $25.00
Admission for two people is $35.00 in total ($17.50 each)
Admission for three people is $45.00 in total ($15.00 each)

How many tickets would you like:

Please indicate your method of payment:
 Cash Cheque Money Order Visa Mastercard

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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