Event Registration - International Day of Older Persons: Community-Research Connections with Long Term Care Survey

This event will be held on October 1, 2026 8:30am-12:00pm at the Holiday Inn Winnipeg South, 1330 Pembina Highway. Please complete this form by September 25.

**For Centre on Aging Research Affiliates and people who work in a PCH: Before starting, we strongly recommend having a photo available to upload and a completed photo consent form. To receive a photo consent form or if you are unable to upload, please email coaman@umanitoba.ca.

Notice regarding collection, use, and disclosure of personal information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of processing your registration for the event, determining catering orders and seating arrangements, providing an accessible venue, and for further communication regarding the event. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information, contact the Access and Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.

1.Please provide the following contact information

First name

Last name

Job title

Work email address

Work phone

2.Why do you want to attend this event?

3.Which category are you?(Required.)

Affiliated with at least one Personal Care Home (PCH)

Centre on Aging Research Affiliate

Family member or caregiver of a resident