Registration

First Name (required)

Last Name (required)

Email Address (required)

Please re-enter your email address (required)

Full Address (required)

Primary Phone Number (required)

Cell Phone Number

Emergency Contact Name and Number (required)

Total Attending (required):

List of Registrants (required):

Please provide full names for each registrant and ages for any registrant under 17

Please check if you wish to register:  KlezKanada Poetry Retreat

Accommodations (required):

Prices are per person. For accommodation details, please refer to descriptions at the top of the page.

Travel Plans:

Please let us know how you will be arriving

Flight Details:

If you are flying into Trudeau and meeting one of our shuttles, we need your Airline, Flight Number, and Arrival time

Shuttle Service TO KlezKanada (required):

Will you need a shuttle from Montreal to Camp B'nai Brith? $30 per person.

Shuttle Service FROM KlezKanada (required):

Will you need a shuttle from Camp B'nai Brith to Montreal? $30 per person.

Dietary Requirements (check all that apply) (required):

 None Vegetarian Vegan Lactose Intolerant Gluten Intolerant Other

Are there any other medical problems that we should be aware of?

Total Payment (required):

Method of Payment (required):

We will contact you to arrange payment.

 Cheque (please mail) Credit Card (please contact us - see sidebar for contact details)