eView 2010 Online Registration Form




First Name: 

Last Name: 

Address: 

City: 

Province: 

Postal Code: 

Phone: 

E-mail: 

Age:

Grade: 
    If you have graduated from high school, please indicate grad year: 

Gender:  

Leader: 

Church/Youth Group Name (if attending): 
    *Note: Check with your group leader before sending in your registration, as they may be collecting all the forms to send
     together


Medical Health Number: 

Emergency Contact:           Relationship to Registrant:      

Emergency Contact Phone Number: 

Permission and General Release:
I agree to attend and participate in the activities at eView 2010. I agree to release and save harmless Peace River Bible Institute for any actions, claims or demands.
I agree 

Request to stay with (friend and/or student): 

Please indicate weekend attending: 
    *Deadline for Feb. 4-6 is Jan. 25
    *Deadline for Feb. 18-20 is Feb. 8