Zoroastrian Youth Lifeskills Workshop Registration

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Thanks for your interest in the Zoroastrian Youth LIfeskills Workshop! Please fill out the form below. Once we have received your registration information you will receive instructions to submit the registration fee via email. Fees can be paid using major credit cards via Paypal. The Early Bird Rate of $212 CAD is available till June 15 2009. After June 15th the Regular Rate is $260 CAD. If you have questions please email us: zlifeskills@gmail.com.

First Name *

Last Name *

Gender *

Date of Birth *

DD/MM/YYYY

Address *

City, State/Province Postal Code *

Email Address *

Telephone Number *

111-111-1111

Emergency Contact's Name *

First and Last Name

Relationship to Emergency Contact *

Emergency Contact's Telephone Number *

111-111-1111

Are you in your last year of high school? *

Yes

Will you be attending college within the next year? *

Yes

Will you be moving away from home within the next year? *

Yes

Would you like your name and email address published in a contact list for workshop participants?

Yes

Clear selection

Meal Preference

Additional Information

Medical conditions, allergies, etc...

Questions, Comments, Suggestions?

Submit

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