Registration Form On-line registration and payment for the 2018 Canadian Boomerfest. If you do not wish to register on-line, click here to download a hard copy registration form. Payment must accompany registrations. On-line Registration Form First Name*Last Name*Email Address* Enter Email Confirm Email Phone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Year of Birth (optional)While this field is optional, it would be helpful. It is collected for the sole purpose of defining the demographic of conference attendees and will not be associated in any way with the provider.Workshop RegistrationPlease indicate which workshop you will attend on Thursday, October 18, 2018 at 3:30 pm. This will enable us to provide adequate space for each workshop. The workshop you select may not be available. We will make every effort to contact you before the Conference if this occurs."New Rituals for New Life Stages" - Rabbi Richard Address"The Complexities of Compression: Caring for Yourself while Caring for Others" - Rev. Jane Keufper"What's Wanted and What's Possible: Responding to Boomers, Xers, and Millenials" - Dr. Reginald. W. Bibby"The Future of Ministry with Boomers" - Rev. Dr. Craig Kennet Miller"Getting a Heart of Wisdom: The Psychological and Spiritual Tasks of Our Older Years" - Rev. Dr. Anne Beattie-Stokes"Living Abundantly in the Second Half of Life" - Mardi TindalAffiliationConsent for use of your personal image*Individual and group photos may be taken throughout the conference. By indicating yes, you agree to the use of your image for promotion and display purposes for 2018 Canadian Boomerfest. By indicating no, you agree to advise those recording your image of your desire not be included.Yes, I agreeNo, I do not want my image recordedDietary ConsiderationsRegrettably, we cannot accommodate specific dietary needs. We have made every effort to include vegetarian selections amongst the items being offered.Registration Fee Price: $ 175.00 CAD The registration fee increased to $175.00 CAD on September 18, 2018. Payment can be sent by cheque to: Siloam United Church, 1240 Fanshawe Rd. East, London, Ontario, Canada, N5X 3Z8. On line payment can be made from the registration confirmation page you will receive after submitting this form.