roncesvalles-polish-festival-event-registration-form-ms-word by nuhman10


									                        Application Form
   First Name, Last Name
   Phone Number
   Emergency Contact Name
   Emergency Contact Number
   (if applicable)
   Food Allergies, please list
   Date of Birth
   Health Card Number
   Check one:                       I have my own                I will be
                                    accommodations            staying at the
                                                              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

   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
   If you have any questions      
please contact us at:                               647-308-7685
     For more information visit:                       
                               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


-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:_______


                                             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
             email:
             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:

   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.

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 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

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!

To top