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  Registration Form Northern Nite 2026 Chilliwack, BC.
Dates: Oct 16/17, 2026

Name(s):(You & escort) __________________________________

Address:
__________________________________________

Phone Number:
________________  Cell: ________________

E-mail:
___________________________________

Cost per person is: $110.00 (Friday only $50.00, Saturday banquet only $80.00)
There will be no refunds if you cancel after August 15th 2026.
Once the limit of
150 registrants is reached a Waiting List will be started.
REGISTRATION DEADLINE IS AUGUST 15th
2026.

Do you or your escort have food sensitivites? Specify:____________________


Send the Registration Form along with your cheque payable to:  

Ken Jones #15-42312 Yarrow Central Rd, Chilliwack, BC V2R 5E2
                                          
OR
Do an e-transfer to:
k29j32@gmail.com 
In the optional notes of the e-transfer state name(s) of those
registering, address, phone #s, email address & food allergies.
Security Question if needed:  Home of RCMP.  Answer: DepotDepot.
Select your own Security Question and answer if you wish.

Receipts will not be issued. 
Your cancelled cheque or e-transfer confirmation will be your receipt.
Confirmation of your registration will be your name(s) appearing at:
 
www.northernnite.com/registrants.htm

Are you interested in a Wine Tasting tour to Whispering Horse Winery? 
            Yes
    No□     Cost to be determined.