Program Registration Form

This is the universal registration form used for all the programs we offer. Section 1 and Section 8 are for all programs. Sections 2-7 are specific to particular programs. Please read carefully and complete only those sections that are indicated for your program. Fields marked with the ++ symbol must be filled in.

Section 1

Name:

Address:

Telephone:

Cell phone:

E-mail:

Date of Birth:

 Sponsoring Denomination/ Congregation/ Agency:

Post-Secondary Education:

Special Interests/ Talents:

(e.g. music, theatre, fitness, etc.)

Spouse's Name:
(if married)   

Names and ages of children who accompanied (or will accompany) you
on your overseas placement (if any):

Section 2
For participants in Orientation, Re-Entry and Renewal Programs:

Section 3
For participants in Re-Entry, Renewal and Debriefing Programs:

List the countries in which you have served with dates of service
(Please press Enter after each country entry):

(Country, From (year/month/day), To (year/month/day), Capacity)

If Yes, please describe your experiences (so we can help address
these kinds of situations):

Date of arrival back in Canada (or the United States)

Section 4
For Participants in the Re-Entry and Debriefing Programs:

If Yes, please describe:

Please describe any future plans:

Section 5
For Participants in the Renewal Program:

Date of return to your placement country

What issues are most important for you at this time:

Section 6
For Participants in Orientation Programs:

Please describe anticipated overseas placement, if known
(where and what):

Work or related experience to global cross-cultural ministry:

Previous overseas experience (please indicate country, assignment,
and dates of service):

What training or orientation have you had in preparation for
cross-cultural and/or overseas assignments?

What do you consider to be your most important needs in preparation
for overseas service at this time?

Section 7
For participants in Mission Trip Leaders' Training Programs:

Country your group plans to visit:

Nature of the mission trip:

Mission trip Start date:

Mission trip End date:

What past experience do you have leading trips?

What issues are most important to you right now as a mission trip leader?

Section 8
For Participants in ALL programs:

Accommodation:

• I would prefer to share a room with:

Special Dietary and Other Needs:

• Other dietary needs or food allergies (if any):

• Other (non-food related) allergies (if any):

Section 9
For participants registering as individuals, or through churches or organizations which are NOT members of the Canadian Churches' Forum:

Please fill in the following information for billing purposes.

Name of Organization:

Name:

Address:

Telephone:

Cell phone:

E-mail: