Enter Workshop Dates:

Your Name (as it is to appear on your certificate)

Title

Organization

Address

City, Province, Postal Code

Phone

Email Address

Post-Secondary School

Student ID No.

To qualify for student pricing, students must submit a copy of their student identification card either as a scanned document attached to an email sent to info@vicrisis.ca or as a fax sent to 250-753-2475.

ASIST Registration Part 2: Payment Method

As per our registration policies, payment must accompany this personal information form.

1. eTransfer payment via etransfer@vicrisis.ca (receipt provided by registrant's banking institution)2. Credit Card by calling VICS (office is open Monday to Thursday, from 9 to 12 and 1 to 4)3. PayPal Shopping Cart4. Cheque via post (not available within 14 business days of first date of workshop presentation)

 

Would you like to subscribe to receive our email announcements?

YesNoAlready Subscribed

 

Additional Comments:

I have read and understood the Course Registration Policies. Yes

I have read and understood Vancouver Island Crisis Society's Communicable Disease Prevention Recommendations for Workshop Participants and Trainers (protocols do not apply if facilitated online). Yes

I understand that payment is REQUIRED to be registered. Yes