North Shore ConneXions Society

Please fill out the form below to register.

Member’s Name:

Name of individual performing registration, if different from member:

Member’s Phone Number:

Member’s Address:

Member’s Email:

Current Member of The Summit:

Yes

If you would like to register for more then 15 courses, please log back on and fill out again after you have submitted the first 15 courses:

(If not you will need to download and fill out a Membership Form)

Course #1

Course Name:

Date:

Price:

Course #2

Course Name:

Date:

Price:

Course #3

Course Name:

Date:

Price:

Course #4

Course Name:

Date:

Price:

Course #5

Course Name:

Date:

Price:

Course #6

Course Name:

Date:

Price:

Course #7

Course Name:

Date:

Price:

Course #8

Course Name:

Date:

Price:

Course #9

Course Name:

Date:

Price:

Course #10

Course Name:

Date:

Price:

Course #11

Course Name:

Date:

Price:

Course #12

Course Name:

Date:

Price:

Course #13

Course Name:

Date:

Price:

Course #14

Course Name:

Date:

Price:

Course #15

Course Name:

Date:

Price:

How would you like to receive your invoice:

Mail

The Summit Online Registration