2019 Leader’s Dinner Registration – New Brunswick Liberal Association

Thank you for supporting our fundraising event.

We are grateful for your donation to attend our upcoming Leader's Dinner fundraising banquet on Friday, October 28, in Moncton.

Please RSVP by Thursday, October 27th.
Will you be attending this event?*
- Yes, I would like to purchase a ticket
- I can't attend the event but I would like to support it with a donation

I would like to donate this amount per seat*
Quantity*
Maximum yearly contribution is $3000 per individual.
Total
$ 0.00 CAD
Please indicate any dietary restrictions you and/or your guests may have (if applicable)
- Vegan
- Vegetarian
- Gluten Free
- No pork products
- Nut allergy
- Seafood / Shellfish allergy
The venue will do its best to accommodate any dietary needs that your or your guest(s) may have.
Your guest list (if applicable)
For multiple RSVPs to this reception, please indicate your guest(s) here. Indicate which guests have dietary restrictions (if applicable.)

I won't be attending but I would like to support the following event:
Can't join us? Show support by making a general contribution to the event. Your donation may be eligible for a tax credit.
Please note: corporations, businesses and trade unions cannot make political contributions in New Brunswick as of June 1st, 2017. Please ensure that all donations, ticket purchases, and convention fees are made on behalf of an individual using only a personal credit card and/or personal cheque.
Frequency*
- Monthly
- One-Time
Donation
- $5
- $10
- $50
- $100
- $250
- Other
Other Amount
Total
$ 0.00 CAD

Please note: corporations, businesses and trade unions cannot make political contributions in New Brunswick as of June 1st, 2017. Please ensure that all donations, ticket purchases, and convention fees are made on behalf of an individual using only a personal credit card and/or personal cheque.
Name*
First Last
Phone*
Email*
Billing Address*
Street Address City Province Postal Code
I would like to give my donation to…
You may direct your donation to a specific provincial riding or to the NBLA central fund.

Type of payment*
- Personal Credit Card
- Personal Cheque
Personal Contribution*
- I am making this donation with personal NOT business/corporate/trade union funds. No entity will reimburse me.
This donation amount may be eligible for a provincial tax credit.

Your registration address must match the billing address for the credit card submitted below. If fraud alert message is displayed, please note your submission has been received and will be reviewed by our office. You do not need to complete the form again.
Total Amount:
$ 0.00 CAD
Credit Card

American Express
MasterCard
Visa
Supported Credit Cards: American Express, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
There is a short delay for processing after clicking the “Submit” button. Please click the button once and wait for the Thank You page to appear.

Please deliver your cheque as soon as possible to:
New Brunswick Liberal Association

715 Brunswick Street

Fredericton, NB, E3B 1H8
Hidden
Do you acknowledge that payment must be received by the NBLA prior to the event?
- I understand.
Total Amount:
$ 0.00 CAD
There is a short delay for processing after clicking the “Submit” button. Please click the button once and wait for the Thank You page to appear.