Register

You now have several options to register. Use the form below or download the printable form on the right, fill it and mail it to us. Be of the first ones to experience the very first Young Adult Camp.

Camp selection
Ages 20 and up Aug 3 - 5	YOUNG ADULTS CAMP 2012 cost $25.00
Camper information
First Name *:
Last Name *:
Option Male Female
Birth Date* :	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962
Mailing Address
Address *:
City or Town *:
Province *: NL NS NB PE QC ON MB SK AB BC YK NT NU
Postal code *:
Phone Number *:
Email Address *:
Home Church
Church Name *:
Pastor *:
In Case of Emergency
Emergency Contact * :
Emergency Phone * :
Payment
Camp fee is TBA. This amount will be charged to your credit card and appear on your statement as Pentecostal Assembly of Canada. If you prefer to register with Credit Card via telephone, please call 1 (902) 895-4212.
Method of Payment*	Mastercard Visa
Card Number :
Expiry Date*	Exp. Month : 1 2 3 4 5 6 7 8 9 10 11 12 Exp. Year : 12 13 14 15 16 17 18 19
Card Holder Name :
General Comments
Comments :

Printable Forms

If you prefer snail mail to register simply download, print, fillout and mail the forms below.

1. Young Adults Registration Form
   480 Kb

Adobe Acrobat Reader
is required for viewing and
printing registration forms.