CYM Education and Outreach (E&O) Registration Form for On-Line Courses
For more information, visit or contact the E&O Education Sub-Committee at

E&O plans to have a minimum of 7 and maximum of 10 people for each course.

Please remember to tell us what times you are available by filling in the poll at the bottom of this form.

CYM warmly welcomes any donations you are able to give. Canadian Yearly Meeting, 91A Fourth Ave, Ottawa ON K1S 2L1. To donate by credit card, call the CYM office at 1-888-296-3222.

Courses and Start Dates (start dates will be determined based on interest, and registrants will be contacted) *
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Meeting Affiliation *
Your answer
Are you a Member or Attender? *
Address 1: *
Your answer
Address 2:
Your answer
City/Town *
Your answer
Province *
Postal Code *
Your answer
Your Time Zone *
Primary Phone *
Your answer
Secondary Phone
Your answer
How did you hear about this course? *
Your answer
Please indicate what times you are available. Sessions will be scheduled based on the number of checkbox votes received for each proposed time. Any times left blank will be treated as a 'no' response. (All times listed are Eastern time).
The above times are in Eastern time, which may not be your local time zone. Are your responses above accurate? *
Comments or questions?
Your answer
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