Application Form First Name, Last Name E-mail Phone Number Emergency Contact Name Emergency Contact Number University/College attending (if applicable) Food Allergies, please list Date of Birth Health Card Number (optional) Check one: I have my own I will be accommodations staying at the festival accommodations: Global Backpacker’s Hostel: 460 King Street West Check one: I am a member I am a I do not belong to of a polish member any polish club club or of PISK or organization organization (specify): __________ Check one: I am coming I am coming as part of a by myself group (specify):_________ I would like to be added to Yes No the PISK mailing list to receive information about current Polonia events in the community If you have any questions email@example.com please contact us at: 647-308-7685 For more information visit: www.polishfestival.ca www.pisk.ca Event Registration Please mark an "x" beside all of the events in which you are interested in attending. Friday September 16th, 2011 Snacks and Icebreakers / Workshops on Community Leadership 4:00pm-7:00pm Location: SPK, 206 Beverley Street Summer Sensations Dance Party 8:30pm-1:00am Location: High Park Curling Club, 100 Indiana Road Saturday September 17th, 2011 Traditional Harvest Parade 12:00pm-1:00pm Location: Roncesvalles Avenue Best Kielbasa in Town 2:00pm-3:30pm Location: PISK Stage Mr. Polonia 4:00pm-5:30 pm Location: PISK Stage YPCPA Summer Social 6:30pm-8:30pm (followed by guest star Anna Cyzon 9:30pm- 10:30pm) Location: Fat Cat Wine Garden Sunday September 18th 2011 Roncesvalles Amazing Race 11:00am-12:30pm Location: Roncesvalles Avenue Screening of Kieslowski's Film "Red" 7:00pm-9:00pm Location: Revue Cinema, 400 Roncesvalles Avenue Note: -Admission for registered "Szalone Lato z PISKiem" participants is complimentary to all of the events, except for the "Summer Sensations Dance Party" for which we offer a special discounted rate of $10.00. - Registered participants will be listed on each of the events guest list and will receive free admission* and priority seating. Please bring photo I.D. to all of the events. *excluding the Summer Sensations Dance Party Payment Form Item Price Please mark an "x" in all which apply. 1. Accommodation at Global $23.00 Backpacker’s Hostel for Friday September 16th 2011 2. Accommodation at Global $23.00 Backpacker’s Hostel for Saturday September 17th 2011 3. Summer Sensations Dance Party $10.00 Discounted Admission 4. Szalone Lato z PISKiem $10.00 Official T-shirt Size options: XS, S, M, L, XL Size:_______ Total Payment Options 1. By Cheque Made out to: Roncesvalles Polish Festival Youth And mailed to: Festival Coordinator 275 Hollymount Dr. Mississauga, ON L5R 3P8 Must be mailed out no later than September 5th, 2011. 2. By Email Transfer To transfer money you must have access to your online banking website. 1) Locate interac e-Transfer usually found in the Transfer Payments menu 2) Fill in the Interac e-Transfer information which should include the following information email: firstname.lastname@example.org Your payment amount A security question or password you must formulate: The answer of the question or password should be “Polish Festival” You will receive a notification when the money is withdrawn. For more information on using interact through email transfers please visit: http://www.interac.ca/consumers/productsandservices_ol_eTransfer.php 3. By Cash (for GTA area) Please call us at 647-308-7685 and we can arrange a meeting in Toronto. 4. By Direct Deposit From your account to ours: Account Name: Roncesvalles Polish Festival Youth TDCT. Account No: 05432 (transit #), 004(institution #), 83955229874(Account#) Please email us once you have made your payment. Accommodations Please note that the securing of accommodations is on a first come, first served basis. We reserve the right to refund your payment and revoke your hostel accommodations if our capacity has been reached. You will be notified two business days after we have received your payment if your accommodation has been approved or refused. We will do our best to accommodate everyone. Please complete this form and send it to email@example.com as soon as possible to secure your accommodations and event admission. Accommodations will only be secured once payment is received. You will receive an email notifying you that your accommodations have been secured up to two business days after your payment has been received. Even if you are not using our accommodations, you must fill out this form and submit it to us via email, to secure your complimentary event admission. Please note, guests who will be staying at the Global Backpacker’s Hostel, will be required to sign a waiver of release of liability upon check-in. We are looking forward to hosting you at the “Szalone Lato z PISKiem” program in September. Let’s make this year’s Roncesvalles Polish Festival an unforgettable one!
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