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Alpha
Please fill out this form to register for Alpha. Your information is kept confidential. We ask you to register so that we can plan for enough food. If you have any questions or concerns, please contact Kim Bornais at
kbornais@dol.ca
or 519-816-8154.
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Name
*
Your answer
Phone number
*
Your answer
Email Address
Your answer
Have you attended an Alpha before?
Yes
No
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Do you have any dietary restrictions or allergies?
Your answer
What is your age?
under 18
18-25
26-35
36-50
50-70
70+
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Is there someone you would like to sit at the same table with? (If yes, please provide the name(s) below.
Your answer
Do you have any questions or concerns at this time?
Your answer
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