The Future of Knowledge Mobilization and Public History Online

Active History Workshop Registration
Payment form for Active History Workshop. Select below your payment option: // Utilisercette forme pour payer les frais d’inscription pour L’Atelier d’Histoire Engagée.
Name/Nom*

First NameLast Name
Email/adresse e-mail*
example@example.com
Affiliation ( For a Name Tag)
Project Code

Registration

Registration Fee

$100.00CAD

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Active History Workshop Registration