ASIST Registration Form
Date: May 9-10, 2022
Location: Lakewood Alliance Church Time: 8:30-4:00 both days
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Employer/Organization Representing (If Applicable)
Any additional needs (mobility, allergy, etc.)
Facilitated by: Josiah Barton, YFC Prince George and Judy Stronstad, Crisis Centre for Northern BC
Registrations are non-refundable, but are transferable. Contact josiah@princegeorgeyfc.ca for more info.
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ASIST Registration
ASIST Registration
$
200.00
CAD
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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