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CanadaDE 2024 Registration Form

Halifax, Nova Scotia - Sunday, June 2 to Friday 7, 2024

The following is collected so that we have the information we need for all aspects of this course. Your information will not be shared with anyone outside the DE program.
* First and Last Name (and pronouns if you wish):
0/50
* Credit Union, Co-operative or Organization(s) (list only those that are relevant to DE):
0/250
* Relevant Job or Role Title(s):
0/250
* How many years have you been engaged in the co-operative and/or credit union sector?
* Email Address for Program Correspondence:
0/50
* Mailing Address: Street, Town, ZIP/Postal Code:
0/250
* Country
0/50
Cell Phone #, including international code (for use during CanadaDE):
0/50
* Emergency Contact - Full Name, Relationship to You, Phone # (including international code), Email Address:
0/250
* Do you have any allergies (food or otherwise) or health-related intolerances (food)?
0/250
* If you answered YES or OTHER to the previous question, specify your allergies here (e.g. shellfish, dairy, gluten, bee sting) and indicate severity clearly (e.g. intolerant, severe reaction, anaphylactic, etc.). If you answered NO above, simply type in not applicable below.
0/250
* Do you have any dietary restrictions that are not allergies or health related intolerances? If YES, be specific (e.g. no pork; vegan; vegetarian but eats fish; etc.). If you have no restrictions, state NO as your response.
0/250
* Describe any accessibility challenges (e.g. climbing stairs or walking or others). Some of the program activities may be in buildings that aren't accessible by wheelchair, may require climbing flights of stairs or standing, may provide an option for a longer walk (other transportation options can be provided if/as required).
0/250
* Do you have any health concerns that the CanadaDE staff should be aware of? If yes, please provide basic information and indicate whether any accommodations are required during the program (e.g. fridge required for medication).
0/250
* A CanadaDE branded shirt (red) is included with your registration. The shirts are ethically sourced. Please indicate your shirt type (the company offers 'Men's' or 'Women's') and size (SM, MED, LARGE, XL, XXL). If you do NOT want a shirt, state NO SHIRT as your response.
0/50
For registrants located outside of Canada, you must complete your home country/region DE program (if available/applicable) before attending CanadaDE. Confirm the DE program that you graduated from and the year of completion (e.g. AfricaDE 2018, US CUDE 2019, CaribDE 41 in X year, etc.).
0/50
Do you have any questions or concerns? If so, specify those here and someone will get back to you by email. If you have special notes on your course fees, bursaries or invoicing, please indicate those here as well.
0/250
 

Thank you for your registration! An invoice will follow via email. Please contact Jude Robertson, ICCM Operations Administrator ([email protected]) with any questions.
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