THE ATLANTIC SUMMER CONFERENCE

MOUNT ALLISON UNIVERSITY

SACKVILLE, N.B.

August 5-7, 2011

REGISTRATION FORM

Reg. No: _______

Name:_________________________________________________

(One Married couple/Individual per form)

Address:_______________________________________________

City:________________________________ Prov:______________

PC:__________________________ Phone:___________________

ACCOMMODATIONS:

Because of Renovations to Windsor Hall there are no

regular single or double rooms with bathrooms down the hall.

All rooms will be in Campbell Hall

Ensuite Room(bath +1 Bed)

______No of nights @ $50.00                                           $___________

Double Ensuite(bath +2 Beds)

______No of nights @ 80.00                                             $___________

MEALS (5 Meal Plan) @ $55.00                                     $____________

REGISTRATION FEE:

SINGLE @ $50.00                                                            $____________

MARRIED COUPLE @ $90.00                                      $____________

STUDENT & YOUTH @ $15.00                                     $____________

FAMILY @ $100.00*                                                       $____________

OFFERING (To help defray costs

and aid others to attend)                                                  $____________

RENEWAL CENTER OFFERING

(Operating Expenses)*                                                     $____________

TOTAL AMOUNT SENT:                                              $____________

Cheques made payable to:

Atlantic Service Committee, P.O. Box 225, Amherst, N.S. B4H 3Z2

PLEASE NOTE:

Registration Fee must accompany all registration forms.

($25.00 non- returnable fee for cancellations)

For further information: Phone: 1-902-667-7179 or Fax: 1-902-667-7017

E-Mail: asc@ccrsatlantic.ca