Tseshaht First Nation | AIRS Healing Event

AIRS Healing Event – Registration

Participant Information

First Name

Last Name

Maiden Name

Traditional Name

Preferred Name

Preferred method of contact?

Phone

Phone #

Email Address

Address

City

Province

Postal Code

First Nation

What is your Nation's Dialect

Are you a fluent speaker

Are you a former residential school student?

Yes

If yes, which school did you attend?

Full Name

Relationship

Phone #

September 27 & 28, 2019 - Tseshaht First Nation Port Alberni, BC