Mission Discernment Event Registration

MISSION DISCERNMENT PROGRAM REGISTRATION

Contact and Sponsor information:

Name (required)

Email (required)

Address (required)

Telephone (required)
Cell phone
Name of sponsoring agency (required)

Program fees should be billed to  Sponsor  Participant

Personal and Family information:

Gender  Female  Male
Date of Birth
Post-secondary education

Special interests and/or talents

Travel information:

How are you travelling to the Mission Discernment Event
(if known*)?

*If you have not made travel arrangements yet, please notify the
Forum as soon as you have arrival and departure information.

Arrival date and time

Departure date and time

Accommodation and Special Needs:

• Accommodation rates are based on double-occupancy.
  If you prefer single-occupancy, and space is available,
  would you pay an additional fee for it?  Yes No
• I would prefer to share a room with
  

Special Dietary and Other Needs:

• I prefer vegetarian entrées only:  Yes No
• Other dietary needs or food allergies (if any)
  
• Other (non-food related) allergies (if any)