PLEASE NOTE: In order to successfully register for this workshop all questions below must be answered and submitted.

The personal information in this e-mail is collected under the authority of the Health Protection and Promotion Act, 1990, s. 9. The information will be used for administration of the Registration/Workshop and will not be shared outside of the program. Questions about this collection can be directed to Lucy Bettencourt (416) 338-1732

Date Form Submitted

Date

Are you a placement student ?

Do you work for an agency/organization which is located OUTSIDE of Toronto?

Toronto postal codes begin with an "M"

Please provide the full Organization/Agency name (no acronyms).

Please provide full mailing address, including postal code.

Job Title

Do you have an Agency/Organization email address?

Please enter 1 email address only

Do you have an Agency/Organization telephone number?

This field must be a 10 digit phone number in ###-###-#### format.

Do you require an accessibility accommodation?

*TPH is committed to creating an accessible workshop by removing barriers for people with disabilities.

If you require any further information, please call Toronto Health Connection at 416-338-7600, option 1. Regular business hours (Monday to Friday, 8:30 a.m. to 4:30 p.m). A Customer Service Representative will be pleased to assist you.