Enter Workshop Dates:

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

Title

Organization

Mailing Address (for print CIST certificate)

City, Province, Postal Code

Phone

Email Address

Post-Secondary School

Student ID No.

To qualify for student pricing, students must submit a scanned copy of their student ID card or other administrative document, which show current dates of study, attached to an email sent to info@vicrisis.ca.

Learning Environment

1. Our Training Centre in Nanaimo2. Zoom digital conferencing platform

CIST 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)

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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