Trip Registration | Fifth Gospel Encounters

ONLINE REGISTRATION FORM

Choose Trip Date

Full Name *
*name must be exactly as printed on Passport
Preferred First Name

Passport
Nationality
Passport #
Expiry Date

Address
Street Address
City
Province/State
Postal/Zip Code

Country

Phone
Home
Work
Cell

Email

Date of Birth

How did you hear about us?

Additional Comments:

FINANCIAL ASSISTANCE

Note: As a student, professor, pastor or missionary, I am requesting Financial Aid.
Click to Download the Financial Aid Application Form.
Yes No
Financial Aid application deadline is 60 days prior to the Rendezvous Date for your trip. Your Rendezvous Date is shown under the SIGN UP tab.

ROOM OCCUPANCY PREFERENCE (DOUBLE? or SINGLE?)

Yes, I would like to have a roommate. I choose
NOTE: On a first come first serve basis, roommates are assigned by gender if:
1) your choice of roommate is not indicated and 2) single room occupancy fee is not included.

Yes, I prefer single accommodation. I am sending my single room occupancy fee with my Registration Form. (Please see Item #3 of the "Price does not include" section under the SIGN UP tab to learn the US Dollar cost for single room occupancy).

Please make cheques payable to COQUITLAM ALLIANCE CHURCH
Address is shown at left, below.

MAIL TO:
COQUITLAM ALLIANCE CHURCH
ATTN: Cam Huth
2601 Spuraway Avenue
Coquitlam, BC V3C 2C4

MORE INFO:
Contact Cam Huth
cam@fifthgospelencounters.com