REGISTRATION for CISV Canada's CENTRAL Leadership Training Workshop 2010 Survey

1. Registration for CENTRAL training, 2010

If you have any problems with registration, please email Ryan at leadertraining@ca.cisv.org

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1. Select your CISV chapter

Select your CISV chapter

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2. What is your role at this workshop?

What is your role at this workshop? Village Leader Trainee

Junior Counselor Trainee

Summer Camp Leader Trainee

International Youth Meeting Leader Trainee

Interchange Leader Trainee - 1st Year

Interchange Leader Trainee - 2nd Year

Local Interchange Coordinator Trainee

Village Staff Trainee

Summer Camp Staff Trainee

Observer

Village Program Group Trainer

JC Program Group Trainer

Summer Camp Program Group Trainer

International Youth Meeting Program Group Trainer

Interchange Program Group Trainer

Staff Program Group Trainer

National Leadership Training Committee Member

Other

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3. Please provide us with your mailing address and contact details.

Please provide us with your mailing address and contact details. FIRST Name:
LAST Name:
Address Line 1:
Address Line 2:
City/Town:
Province:
Postal Code:
Country:
Email Address:
Phone Number:

4. Gender?

Gender? Male

Female

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5. Health Card Number

Health Card Number

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6. Emergency name & contact number:

Emergency name & contact number:

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7. When were you born? (DD/MM/YYYY)

When were you born? (DD/MM/YYYY)

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8. What is your dietary preference for the weekend? (If needed, you can provide further dietary information in your answer to the next question. Example: I don't eat pork)

What is your dietary preference for the weekend? (If needed, you can provide further dietary information in your answer to the next question. Example: I don't eat pork) Vegetarian

Vegan

Carnivore

9. Do you have any severe allergies or dietary restrictions we should know about?

Do you have any severe allergies or dietary restrictions we should know about?

10. Do you take any medications that we should know about?

Do you take any medications that we should know about?

11. Where is your CISV camp taking place? (Example: Thailand)

Where is your CISV camp taking place? (Example: Thailand)

12. What is the CISV program number for your upcoming camp? (Ex. V-2008-26)

What is the CISV program number for your upcoming camp? (Ex. V-2008-26)

13. Have you attended a National leadership training workshop before?

Have you attended a National leadership training workshop before? NO

YES

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14. We kindly remind you that every participant is responsible for making their own travel arrangements to the workshop (in coordination with their local chapters). How will you be getting to the workshop?

We kindly remind you that every participant is responsible for making their own travel arrangements to the workshop (in coordination with their local chapters). How will you be getting to the workshop? Carpooling with others from chapter

Ferry + carpool/rental car

Airplane + carpool/rental car

Car rental

Local transit/getting there on my own

15. If you are taking an airplane or ferry as part of your travel to the workshop, please include your arrival and departure times, flight numbers and carrier company if known. This information helps us in the event that someone does not arrive on time for the workshop.
Ex: Air Canada 1234, Leaves Ottawa 3 pm; Arrives Toronto 4pm

If you are taking an airplane or ferry as part of your travel to the workshop, please include your arrival and departure times, flight numbers and carrier company if known. This information helps us in the event that someone does not arrive on time for the workshop. Ex: Air Canada 1234, Leaves Ottawa 3 pm; Arrives Toronto 4pm

16. Please provide a mobile phone number at which we can reach you during your travel to the workshop (if available):

Please provide a mobile phone number at which we can reach you during your travel to the workshop (if available):

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17. A contact list of leaders will be prepared and sent to local and national trainers. Do we have your permission to include your contact information?

A contact list of leaders will be prepared and sent to local and national trainers. Do we have your permission to include your contact information? NO

YES

REGISTRATION for CISV Canada's CENTRAL Leadership Training Workshop 2010

1. Registration for CENTRAL training, 2010

*1. Select your CISV chapter

*2. What is your role at this workshop?

*3. Please provide us with your mailing address and contact details.