Active Transportation Leadership Workshop - Registration

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Thank you so much for your interest in the AT Leadership Workshop. Please take a minute to answer these questions.

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* 1. Name & Affiliation

First Name

Last Name

City

Postal Code

Phone #

Organization

Job Title

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* 2. Please rate your current knowledge of our Youth AT programs and events

	Excellent	Very Good	Good	Not very familiar
School Travel Planning	School Travel Planning Excellent	School Travel Planning Very Good	School Travel Planning Good	School Travel Planning Not very familiar
Walking School Bus	Walking School Bus Excellent	Walking School Bus Very Good	Walking School Bus Good	Walking School Bus Not very familiar
We Often Walk (or Wheel)	We Often Walk (or Wheel) Excellent	We Often Walk (or Wheel) Very Good	We Often Walk (or Wheel) Good	We Often Walk (or Wheel) Not very familiar
Making Tracks	Making Tracks Excellent	Making Tracks Very Good	Making Tracks Good	Making Tracks Not very familiar
Pace Car Program	Pace Car Program Excellent	Pace Car Program Very Good	Pace Car Program Good	Pace Car Program Not very familiar
Welcoming Wheels	Welcoming Wheels Excellent	Welcoming Wheels Very Good	Welcoming Wheels Good	Welcoming Wheels Not very familiar
International Walk to School Day, Week, Month	International Walk to School Day, Week, Month Excellent	International Walk to School Day, Week, Month Very Good	International Walk to School Day, Week, Month Good	International Walk to School Day, Week, Month Not very familiar
Winter Walk Day - Take The Roof Off Winter	Winter Walk Day - Take The Roof Off Winter Excellent	Winter Walk Day - Take The Roof Off Winter Very Good	Winter Walk Day - Take The Roof Off Winter Good	Winter Walk Day - Take The Roof Off Winter Not very familiar
Bike to School Day	Bike to School Day Excellent	Bike to School Day Very Good	Bike to School Day Good	Bike to School Day Not very familiar

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* 3. Which of the workshop locations do you plan to attend?

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* 4. Is there a particular area of interest or aspect of your work (e.g. group age, geographical area, challenges, opportunities, etc.) that you'd like to discuss or focus on? If so, what is it?

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* 5. Food (snacks, beverages & lunch) will be provided. Please let us know if you have any food allergies or dietary needs.

Thank you for completing the registration. Space is limited to 15 people. A notice confirming your registration will be sent to you within a week. For any questions, please do not hesitate to contact us at walk@ecologyaction.ca or stp-cb@ecologyaction.ca. We're looking forward to seeing you there.