Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Emergency Contact
Name
First Name
Last Name
Phone Number
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Choose One(1) Cabin Mate:
Payment
*
Please Select
Cash
Cheque
E-Transfer (books@pottershandsministries.org)
Mastercard
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Paid in
full by July 31, 2025
Early Bird: $160.00
After July 31, 2025
Cost: $170.00
Dietary Concerns (Diabetic, Glutton-Free, etc. NOT DISLIKES
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