Society Representative information

Please complete this first page to verify that you are qualified to represent your society and can nominate TTT candidates. (Submit candidate information on page 2.)

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* 1. Name of WGO Member Society:

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* 2. Name of Society Representative submitting this form (first and surname):

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* 3. I certify that I am able to represent my society and have the authority to nominate a Train the Trainers participant(s).

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* 4. Your Position in your Society:

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* 5. Your email address:

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* 6. Your second email address (optional):

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* 7. Your phone number:

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* 8. Are you completing this form on a different Society Representative’s behalf?

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* 9. I understand that the society I am representing must pay their WGO membership dues through 2017 to have our nominee(s) accepted for the Train the Trainers workshop.

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