2016 Combining Our Strength Leadership Program-Kamloops-Expression of Interest

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33% of survey complete.

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* 1. Contact Information

Name *

Address *

Address 2

City/Town *

State/Province

ZIP/Postal Code *

Email Address

Phone Number *

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* 2. Aborignal Ancestry & Nation/Band (If Applicable):

First Nations

Metis

Inuit

Nation/Band

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* 3. Will you be able to attend the entire program? (entire program includes both May and June dates)

	May 12-15	June 9-12
Please select for each session	Please select for each session May 12-15 menu	Please select for each session June 9-12 menu

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* 4. Please comment if you have selected no:

*****Please note that there are different start and end times for certain days of the program. Once you have completed this form, we will contact you with information regarding this. Thank you

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* 5. Do you foresee any barriers that may keep you from fully participating in the program?

Yes

If Yes, what are the barriers?

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* 6. The Community Leadership Program is a project based program. Are you comfortable to work on a project for your community either alone, or in a group?

Yes