CWCF Conference / CoopZone Forum Registration 2010
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1. CWCF Conference Registration Form

 
This is the on-line registration form for the CWCF Conference and CoopZone Forum, being held in Vancouver, BC from October 28-30, 2010.

All questions with an asterisk must be completed. You can go back to previous pages in the survey and update existing responses until the survey is finished or until you have exited the survey. After the survey is finished, you will not be able to re-enter the survey. In case of more than one person attending from your organization, note that it is possible to complete multiple forms on one computer.

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1. Name (in format: last name, first name):

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2. Organizational or worker co-op affiliation:

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3. Are you (or is your co-op) a member of CWCF or CoopZone?

4. If 'No' to the above, are you interested in becoming a CWCF or CoopZone Member?

5. If you are a Member of CWCF, what type of Membership do you have?

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6. Are you a Conference Presenter or Co-Presenter?

7. If 'Yes' to the above, what is your Workshop or Presentation Topic(s)?
And do you require A/V or other requirements for your Presentation(s)?

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8. Daytime Phone:

9. Evening Phone (if acceptable to phone from 6 - 9 pm):

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10. Email Address:

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11. Mailing Address:

12. (MEMBERS ONLY): My/our contact information on CWCF's Website (www.canadianworker.coop/basics/members) / OR for developers only: on CoopZone's Webiste (www.coopzone.coop/developers) is incorrect and needs to be updated:

13. You MAY NOT include my name and contact information in the list of participants: