Workshop Registration Form
Registration fee is $257.00. The registration fee includes all week long course materials, lunch, coffee, tea and snacks for breaks on each day of the workshop.

Please make cheque payable to the Niagara District CUPE Council and mail to:

Susan Schmidt
c/o Niagara Area Office
110A Hannover Drive, Suite 101
St. Catharines, ON L2W 1A4
First Name *
Please enter the first name of the participant
Your answer
Last Name *
Please enter the last name of the participant
Your answer
Email Address *
Please enter the email address of the participant.
Your answer
Primary Contact Telephone Number *
Please provide a telephone number you are easily reached at.
Your answer
CUPE Local Number *
The number assigned to your Local. ie: CUPE Local XXXX
Your answer
Street Address #1 *
Please enter the street name and number of the participant
Your answer
Street Address #2
Please enter any additional mailing address information of the participant (ie: suite #)
Your answer
City *
Please enter the city where the participant lives.
Your answer
Province *
Please enter the province of the participant
Your answer
Postal Code *
Please enter the postal code of the participant
Your answer
Workshop Registration *
Which workshop would you like to register for?
Required
Payment Confirmation *
Payment will be forwarded within 7 days of registration or space will be released
Required
Special Requests *
Please indicate if you have any allergies, dietary, access or mobility restrictions.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy