|Participant First Name *|
|Participant Last (Family) Name *|
|Email Address *|
|Email Address to be CC'd|
|Company Name *|
$30.00 for members $30.00 for non-membersI authorize BCIU to charge me the appropriate amount, according to my current membership status with BCIU. I understand that the cost is $30.00 for members, and $30.00 for non-members.