Leadership Workshop Registration Form

Stronger Communities through Stronger Organizations

Addressing the Challenges, Sharing the Successes

Saturday, April 13, 2013

10:00 a.m.– 3:30 p.m.

The Advocates’ Society Education Centre,
480 University Avenue, 17th floor, Toronto, M5G 1V2

Seating is limited so please register as soon as possible.

First Name:
Last Name:
Email Address:
Postal Code:
Phone (Home):
Phone (Work):
Phone (Mobile):
I am a: Board MemberVolunteerStaff (Administrator and/or Executive Director)Other
My Board is: Community Driven Governance Board (well-established community service and program provider usually with an Executive Director and paid staff)Umbrella Board (national or regional umbrella for branches, councils or chapters that have their own local boards)Working Board (board and staff operate as one and works through committees with Chairs)Network Board (Board works through others by providing funding to them to carry out their projects)Don't know
I am mostly involved at the: National levelRegional or local levelNot involved yet
Our organization's yearly budget is: More than $1 millionOver $500,000 but under $1 millionUnder $500,000Don't know

I understand that the workshop is being video-taped and will be used for educational/training purposes in the future. Therefore I hereby agree and give permission to the UCC and UCEF to use my material (photograph, video, name or quotation) without any further compensation to me. I understand this material will be used in communication and materials about UCC and UCEF programs and services and they will be distributed to the public through a variety of means, including printed and electronic communications.
I Agree

The $75.00 Registration Fee (non-refundable) for this workshop can be submitted using PayPal

(Please submit your registration first by clicking the “Submit Your Registration” button above. You will then remain on this page and will see a message indicating your successful registration. Once you have submitted your registration, please proceed to PayPal to pay your registration fee. Thank You!)

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