Registration Form - NARA 2011

Submitted by Alice on Mon, 06/13/2011 - 19:58

Given Name *

Family Name *

Citizenship *

Date of Birth *

Month

Day

Year

Gender Identity?

Address *

Telephone Number(s) *

Email Address *

Are you a member of SCM-Canada or SCM-USA? *

SCM-Canada

SCM-USA

Not active in either movement

Are you from an outside organization? (NGO, other SCM, etc) *

Study area / occupation

Church membership

Do you have a valid passport? (All Canadians must have a valid passport to attend the conference, for legal reasons.) *

Yes

Do you require assistance in obtaining a visa or invitation letter? *

Yes - please give details below in the "Further remarks and special needs" field

Passport Number *

Issued at (place) *

Date of issue *

Month

Day

Year

Date of expiry *

Month

Day

Year

Do you have any dietary requirements? *

What is your personal motivation to take part in this Regional Assembly? *

How will you bring this experience back to your home community and make change? How will you build support for this? *

Further remarks, special needs

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