Registration Form

Salutation
First Name	*
Last Name	*
Gender	*
Date of Birth	*	The date format is day/month/year (example: 13/10/2008)

Street
City
Prov/State
Postal/Zip Code
Country
Email	*	Important program information is sent to this email address
Phone
Mobile Phone
Work Phone
Fax

Last School Attended
Church Affiliation (if any)
Please check if financial assistance is required		Yes
How did you hear about SALTS?

Food Allergy?	Yes No *	Please explain your food allergy:
Vegetarian or special Diet required?	*	Please explain your diet requirements:
Medications being taken
Disability/Medical Allergy
Physical/mental/emotional disability?	Yes	Explain:
Medical Insurance #	*	Application will not be processed completely without this number. If number is unavailable, please explain in comment window. Non BC trainees must ensure they have proper medical coverage for emergencies in BC.

Sailing Experience (if any)
Ship Choice		Note: We will try to reserve your berth on your ship of choice but if the ship is full we will book your berth on the other ship.
Trip Choices
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Car pool information	Yes	We do not arrange car pooling but if you check this box we will distribute your email address to other trip participants interested in carpooling.


Are there any comments you wish to make?

		Once you click the submit button you will receive an email with a WAIVER FORM attached. This must be printed, signed and sent to the SALTS office asap. Thank You.