I am interested in MyRevelstoke2030

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Please provide your contact information below. We will not share this information with the City of Revelstoke or with anyone outside the UBC research team. All information will be stored securely but if you prefer to provide your contact information over the phone, please call Dr. Maged Senbel at 604-822-9158

What is your full name *

We want to make sure you are a real person and not a computer program. We would also like to be able to send you a personal invitation

What is your home address? *

We'd like to have a balanced representation from different parts of town.

Please indicate your age *

This helps us make sure we have good age representation

Will you be able to attend a 2-Hour workshop during the following times *

I can attend a 2-hour workshop some time Tuesday June 5th to Thursday June 7th

I can attend a 2-hour workshop some time Tuesday September 18 to Thursday September 20

I would like to participate but the June dates don't work for me

I would like to participate but the September dates don't work for me

Required

What is your preferred time for the above dates? *

2 hours some time between 8:30am and 12:30pm

2 hours some time between 6pm and 10pm

Required

How do you prefer to be contacted? *

we want to be able to reach you in the way that you prefer

Based on your preferred contact method please give us your mailing address, email or telephone number

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