Please note: Priority for registrations will be given to conferees from Reformed and Presbyterian churches. Conferees from other backgrounds will be considered on a case-by-case basis. If you have any concerns about this restriction, please feel free to contact us to discuss.

Personal Info
First name:
Last name:
Church:
Gender:
Birthday:
Email Address:
Phone Number:
 
Mailing Address
House # & Street:
City:
Province/State:
Postal Code:
 
Workshops
First Choice:
Second Choice:
Third Choice (alternate):
Emergency Contacts
Name:
Relationship:
Daytime Phone #:
Nighttime Phone #:
 
Name:
Relationship:
Daytime Phone #:
Nighttime Phone #:
 
Medical Information
Health Card #:
Known Allergies /
Reaction / Treatment:
Medications / Used
For / When Taken:
Other Medical
Conditions:
 
American Campers
Insurance Carrier:
Policy Number: