First Name
*
Last Name
*
Phone
*
Email
*
City
*
Age
Under 18
18-25
Over 25
Do you identify as any of the following:
*
First Nations
Identify as having a disability
At risk of/experienced family violence
Identify LGBTQI+
Experiencing Financial Hardship
At Risk of Homelessness
I identify with one of the above factors but do not want to identify which one
Were you referred to the Program by CVGT?
*
Yes
No
If you were referred by CVGT please list your site and consultants name
*
Dietary requirements:
*
Why are you interested in the program?
*
Do you agree to photography/video being taken at the event and shared by Empowered Women in Trades, CVGT and event stakeholders for marketing and promotion purposes?
*
Yes
No
Submit
