CRE Gathering April 2023

Registration form

What is your full name?*
What is/are your pronoun(s)?*

If you prefer not to say, enter Prefer not to say.
Date of birth*
What is your email address?*
Enter Email Confirm Email
What is your phone number*
What is your mailing address?*
Street Address Address Line 2 City Province Postal Code
What are your preferred travel days/times?
Which location are you travelling from (or preferred airport)?
Do you need childcare support?*

Please note that our team will work with you specifically for your childcare needs – we will reach out to you individually if you indicate that you require support
Do you have any accessibility needs? This can include specifics about your room.*

Please submit any requests or additional information (gathering@canadianroots.ca) by March 15th so we can accommodate your needs.
Do you have any dietary restrictions?*

Please submit any dietary restrictions by March 15th.
Is there anything else we should know?
Consent*
I agree with the Privacy & Consent Statement
Thank you for participating in this online survey to assess the reach of our activities. CRE will share the results of this survey in a highly aggregated report (no unique identification) to our program funder.
Your participation in this survey is voluntary. You may refuse to take part in this survey, skip questions or exit the survey at any time without penalty.
You will receive no benefits from participating in this online survey, but your responses will help us improve the program. There are no foreseeable risks involved in participating in this online survey..
If you feel you have not been treated according to the descriptions in this statement, or that your rights as a an evaluation participant have not been honored during the course of this program, or you have any questions, concerns, or complaints that you wish to address, please contact CRE’s Privacy Officer James Arruda at james@canadianroots.ca.
You may print a copy of this consent for your records. Clicking on the “Agree” button indicates that: You have read the above statement; You voluntarily agree to participate.
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