Tel: 204-647-2358 | Email: coordinator@taketheleapmb.ca

Registration Form

This online form is only enabled for individual attendance registration. If you would like to sign up for multiple attendees please repeat the process or contact our coordinator Kristen to process the registration manually. You can reach her at coordinator@taketheleapmb.ca
First Name(*)
Please let us know your name.

Last Name(*)
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Business Name
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Address(*)
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City/Town/RM(*)
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Postal Code (*)
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(X1X 1X1)

Province(*)
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Contact Phone Number (*)
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(123-456-7890)

Your Email(*)
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Are you a business owner or an entrepreneur(*)
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Your Facebook Page
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Your LinkedIn Profile
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Entrepreneur with a Disability?
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Your Industry(*)

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Please categorize your industry
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Additional comments or special requests. ie: seating, accessibility, dietary.
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Registration Fee(*)

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Coupon Code
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Applied on payment

Total
0.00 CAD

Please choose your payment option

You can choose the either pay securely online or request an invoice and send us a cheque no later than 72 hours before the event.

Sponsor Info
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Disclaimer:(*)
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I acknowledge that Take the Leap Manitoba reserves the right to use any photograph/video taken at our event, without the expressed written permission of those included within the photograph/video. Take the Leap Manitoba may use the photograph/video in publications or other media material produced, used or contracted by Take the Leap Manitoba including but not limited to: brochures, invitations, books, newspapers, magazines, television, websites, etc.

Any person desiring not to have their photo taken or distributed must contact Take the Leap Manitoba in writing of his/her intentions and include a photograph. Take the Leap Manitoba will use the photo for identification purposes and will hold it in confidence.

Would you like to subscribe to our newsletter?(*)

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Cancellation Policy: In the event that the need arises to cancel your registration please notify us by voice [phone number] or email (coordinator@takeltheleapmb.ca) at least 72 hours prior to the event. Cancellations received more than 72 hours in advance of the event will be able to transfer their ticket to a different person. In the event that a refund is requested we will charge a 50% surcharge to cover administration and transactions fees.

  • Phone
    204-647-2358
  • Email
    This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Address
    Take the Leap Conference
    Box 668
    Gilbert Plains, MB, R0L 0X0
    Canada
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