2019 Leader's Dinner Registration - New Brunswick Liberal Association

Leader's Dinner tickets: $500 each | Tables of 10
Will you be attending an event?*
- I would like to attend an event and purchase a ticket.
- I can't attend an event but I would like to support one.

I would to purchase ticket(s) for:
Quantity
Please enter a number less than or equal to 6.
Maximum yearly contribution is $3000 per individual. A limit of 6 tickets per individual applies.
Total
$ 0.00 CAD

Please indicate any dietary restrictions (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)
If you are purchasing multiple tickets, please indicate your guest(s) here.

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 will 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
Card Number Expiration Date Security Code Cardholder Name

Please send cheque or money order by May 24th to:
New Brunswick Liberal Association

715 Brunswick Street

Fredericton, NB, E3B 1H8
Do you acknowledge that payment must be received by the NBLA prior to the event?*
- I understand.
Total Amount:
$ 0.00 CAD

2019 Leader’s Dinner Registration