ECDSC Registration Form

ECDSC Registration Form

Fill out the form carefully for registration
Select the workshop you will be attending:

Compassion Fatigue, Self Regulation & Self CareOther
Do you plan on attending the 1 hour reflective session on June 21st*

I plan on attending the reflective session (1 hour) June 21stI will not be attending the reflective session (1 hour) June 21st
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
NSCC Student ID #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address*
Organization*
Home Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Emergency contact person, relationship and phone number
Cancellation Policy:

- 50% non-refundable cancellation fee for withdrawal of your registration form 14 days or more prior to the date of the workshop

- NO refund will be issued if you withdraw your registration within 14 days of the date of the workshop
Amount of Payment
Method of Payment
New Policy-

NSCC has a new policy for collecting credit card information. We are no longer able to accept credit card information that is submitted to us via fax, online or email. If you are paying with a credit card you will have to call it in. You can call your paymet into the Business Office at (902) 597-3737 once I have confirmed that you have gotten into the session.
**Please note: any individual owing monies to the Nova Scotia Community College will not be accepted into any program/course until all monies owing are paid in full
Should be Empty: