REGISTRATION FORM

Annual Summer Conference

August 16-18, 2013

Mount Allison University, Sackville, NB

Reg. No: _______

Name:_________________________________________________

(Only one married couple or individual per registration form )

Address:_______________________________________________

City:________________________________ Prov:______________

PC:__________________________ Phone:___________________

ACCOMMODATIONS:

Single Room (1 bed + bath down hall)

______No of nights @ $45.00 for 1 person night $____________

Single Ensuite Room(1 bed + semi-private bath)

______No of nights @ $55.00 for 1 person/night $____________

Double Room (2 beds + bath down hall)

______No of nights @ $75.00 for 2 people/night $____________

Double Ensuite(2 beds + private bath)

______No of nights @ 85.00 for 2 people/night $____________

Note: If you selected a double unit and are not a married couple,

please give your roommate's name: _________________________

______MEAL PLANS (5 Meals) @ $60.00 $____________

REGISTRATION FEE:

SINGLE @ $50.00                                                   $____________

MARRIED COUPLE @ $90.00                             $____________

STUDENT & YOUTH @ $15.00 $____________

FAMILY @ $100.00 $____________

RENEWAL CENTER OFFERING

(To help defray costs and aid others to attend) $____________

TOTAL AMOUNT DUE: $____________

AMOUNT ENCLOSED: $____________

AMOUNT STILL OWING: $ ____________

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 or E-Mail: asc@ccrsatlantic.ca