Event Registration - Fondation Habilitas Foundation

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The Foundation
Our Partners
Impact
Media
- Video Library
- Publications
Ways to Donate
Search for:

fr

Donate Now
The Foundation
Our Partners
Impact
Media
- Video Library
- Publications
Ways to Donate
Search for:

fr

Dinner in the Dark

Event Registration

Name(Required)

First Last

Email(Required)

Phone

Please seat me with

(Every effort will be made to accommodate these requests, but table assignments can not be guaranteed)

Dietary restrictions (choose all that apply)

Vegetarian

Vegan

Gluten Free

Kosher

Halal

Other

Please indicate all that apply

I will be bringing a guide dog

I will be attending in a wheelchair

I am hard of hearing or Deaf

I require other specific accommodations

Dietary restrictions - Please explain

Specific accommodations - Please explain

QFB member $40 | Limited availability Quantity

Price: $ 40.00 CAD

Quantity

Current CIUSSS staff member $50 | Limited availability Quantity

Price: $ 50.00 CAD

Quantity

General Public $60 | Limited availability Quantity

Price: $ 60.00 CAD

Quantity

Add a Donation to Your Purchase (optional)

Enter your donation amount

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Δ

Ticket purchases for this event will not be issued a tax receipt. Please contact Avigail at avigail.aronoff@habilitas.ca with any questions

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2024 Habilitas Foundation All rights reserved.
Charitable Registration Number 82332 8554 RR0001.