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Webinar Registration Form Assisted Suicide

Submitted by Tracy Odell on Mon, 03/16/2015 - 19:06

Registration Form:
Assisted Suicide Webinar Sunday, April 26 3:00 PM Eastern Daylight Time
Hosted by Citizens With Disabilities Ontario (CWDO)

Introduction

Thank you for your interest in this webinar on assisted suicide. If you have never participated in a webinar with CWDO before, Technical Support will contact you about how to connect to our Accessible On-line Conferencing System. We will need your e-mail address or phone number to do so. Your information will not be used for any other reason.

Please enter either your real name (first name and last name).

Registrant's email address – this must be completed if you wish to be on our mailing list.

Please provide your phone number for technical support. CWDO will not share or sell your information to any other party.

Please provide your TTY number for technical support. CWDO will not share or sell your information to any other party.

Please provide your number for text messages for technical support. CWDO will not share or sell your information to any other party.

Registrant's Province

Your city, town or municipality

CWDO is grateful to the Council for Canadians with Disabilities for sponsoring accommodation supports for this webinar. If you require accommodation, please make sure you have given us your e-mail address so we can contact you with instructions for accessing captioning and ASL. Our Accessible Online Conferencing System is compatible for people who use JAWS and has options to resize text.

If you are representing an organization or if you are a member of an organization, please let us know the name of the organization.

If you are a member of the media, please provide the name of your newspaper, radio, magazine, television show, etc.

If you are an elected representative, please indicate if you are an MP, MPP or some other elected official.

Please let us know if you want to receive CWDO's free, monthly newsletters by e-mail.

Registrant's email address – this must be completed if you wish to be on our mailing list.