Dare2B Registration

The Dare2B Conference Registration Form

Registration

1. Attendee First Name(required)
2. Attendee Last Name(required)
3. Attendee Age(required)
4. Attendee Email Addess
5. Daytime Phone Number(required)
6. Attendee Cell Phone Number
7. Parent/Guardian Name(required)
8. Emergency Contact Phone Number(required)
9. Parent/Guardian Email Address(email required)
10. The Church You Attend

Your Address

1. Street Address(required)
2. City(required)
3. State/Province -Please select one- NS NB PE NL (required)
4. ZIP/Postal Code(required)

Medical Information

1. Medical Health Card Number(required)
2. In the event of a medical emergency, I hereby give permission for Steph Robbins’ Ministries to proceed with whatever immediate medical attention/treatment that is deemed necessary.
3. I agree
4. Yes No

1. SPECIAL NEEDS or Instructions: (List food allergies or existing medical conditions)

Payment Method

1. I am paying the registration fee by:
2. Paypal Cheque
3. PayPal button is below. Please make cheques payable to "Stephanie Robbins" and mail them to 20 Robert Allen Drive, Halifax, NS, B3M 3G8

My Copy:

1. Please cc me on the registration submission:

 

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Pay Your Conference Registration Fee with Credit Card via PayPal ($40.00):

If Paying by cheque:

Please make cheque for $40.00 payable to “Stephanie Robbins” and mail it to: 20 Robert Allen Drive, Halifax, NS, B3M 3G8

If you have any questions about your registration or payment, please contact Tina: Tina@StephRobbins.com