Conference Registration Form
September 25 - 27th, 2009
National Nikkei Museum &
Completed registrations can be forwarded by regular mail or emailed to: email@example.com
**Note: All information will be kept confidential and secure and will be seen by conference
Name Birth Date (m/d/y):
Street Address Home phone:
City Cell phone:
INFORMATION ABOUT GROUP PARTICIPATION:
We will do what we can to meet your needs. Please assist us to ensure your participation at this
conference will be as comfortable and enjoyable as possible by checking either yes or no below.
I am 77 years old or older
I remember my experience of the internment
I am comfortable talking about this information
I am comfortable talking about this information but not with a group
I am comfortable in a group with other story tellers only
I am comfortable in a group which may include listeners as well as story
I would prefer to be in a group with my family members
I would prefer to be in a different group from my family members
I would like my story sharing group to be only Japanese Canadian
I require a Japanese language interpreter
INFORMATION ABOUT RECORDING YOUR STORY:
Please indicate yes or no to the following choices:
I give permission for audio or video recording
I give permission for audio recording only
I do not want any recording of my story
**Note: Consent forms for participants will be available at the conference.
I remember my experience of the internment. Please indicate:
Honouring our People: Stories of the Internment Page 1
Please list internment location(s):
Please indicate special needs Yes No
If you would like to attend but will have transportation difficulties, please contact us one week prior
to the conference so that arrangements can be made and we will try our best to arrange for
CONFERENCE COST: Please fill in applicable amount.
Students: (full time, under 30 yrs old) $20.00
Age 65 to 77 years: $20.00
Age 77 years and older Free
*** Registration includes morning/afternoon snacks, lunch & dinner on Saturday.
METHOD OF PAYMENT
Completed registration forms and registration fees can be submitted in person and by mail.
Registration can also be completed online, but registration fees cannot be paid online. Whenever
possible, and for administrative purposes, we ask that you submit your registration form and
registration fee together. Please do not send cash payment in the mail.
1. IN PERSON: Please submit your registration form and payment (in cash or by cheque) at
the GVJCCA office at #200 – 6688 Southoaks Crescent, Burnaby BC. GVJCCA telephone
2. BY REGULAR MAIL: Please mail your registration form with your cheque l to: Greater
Vancouver JCCA Human Rights Committee, #200 – 6688 Southoaks Crescent, Burnaby
BC. V5E 4M7.
3. For registering online please go to: http://jccabulletin-geppo.ca. As registration fees cannot
be paid online, please mail your cheque payment to the above address or go to the GVJCCA
office to make your cash or cheque payment.
Honouring our People: Stories of the Internment Page 2
Out of town participants must arrange own accommodations. We suggest accommodations at the
following hotels which are close to the National Nikkei Museum and Heritage Centre.
1. Best Western Kings Inn Burnaby Hotel
5411 Kingsway, Burnaby, British Columbia,
Canada, V5H 2G1
Phone: 604 438-1383
Toll-Free: 1-800-211-1122 Email: firstname.lastname@example.org
**Special rates for conference attendees at Best Western are:
1 bedroom suites at $89.00 and 2 bedroom suites at $99.00. Continental breakfast is
2. Holiday Inn Express Metrotown
4405 Central Boulevard
Burnaby V5H 4M3
Toll free: 1-877-323-1177 tel: 1-604-438-1881 fax: 1-604-438-1813
3. Hilton Vancouver Metrotown
6083 McKay Avenue,
Reservations: www.hilton.com or 1-800-HILTONS
For more information go to http://jccabulletin-geppo.ca
or Facebook.com – Honouring Our People: Stories of the Internment.
Completed forms may be printed and mailed with your cheque or sent via email to:
To email, click on file and scroll down to mail recipient and type in the above email address. If you
have any problems with this form, call me at: 604.943.3195
Honouring our People: Stories of the Internment Page 3
Honouring our People: Stories of the Internment Page 4