Interest List - Show Up for Safer Workplaces

Want to keep up to date on this program and find out when we'll be offering our first sessions? Join our Show Up for Safer Workplaces email list here:

If you have any questions, please reach out to info@bccwitt.ca.

Name

First NameLast Name

What are your pronouns?

Please share your pronouns:

Email

example@example.com

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If in British Columbia, please select your Economic Region:

What is your gender?

Please tell us your gender:

Are you a member of an(y) equity priority group(s)? (BCCWITT is dedicated to removing barriers and obstacles, so we ask this question to make sure we can provide you with all the opportunities available to you; this is not to exclude anyone from any of our programs)

Do you identify as Indigenous?

Organization (if applicable)

Workplace, union, training institution, community organization, etc.

Job Title/Occupation

Trade or Designation

Level of skilled trade qualification (if applicable):

Do you have a union affiliation?

What union and local? (Please spell out fully)

Do you consider yourself a leader or influential in your organization or trade?

Do you have the support of your employer to participate in this program?

Do you commit to facilitate workshops or share training materials following the completion of the program?

Is your organization (workplace, union, training institution, community organization, etc.) interested in co-hosting a training in your community?

Have you participated in any previous events or trainings hosted or facilitated by BCCWITT?

In what BCCWITT event(s) or training(s) have you participated?

How did you hear about this opportunity?

Is there anything else you'd like to share with us at this time?

Participant Collection of Personal Information Consent
All personal information on this form and other information related to your participation in the Show Up for Safer Workplaces program (“Personal Information”) is collected pursuant to sections 26(c), 26(e), and 27(1)(a)(i) of the Freedom of Information and Protection of Privacy Act (the Act). This information will be used for administrative, evaluation, program development, and/or research purposes, including to determine your eligibility for participation in the program.

If you have any questions about the collection and use of this information, please contact info@bccwitt.ca.

Consent and Agreement

Effective as of the date set out below, I:

Certify that all of the information that I have provided is accurate and complete;
Consent to my Personal Information being used to contact me.

By signing this form I agree that BCCWITT can retain my personal information for the purposes of contacting me. I understand that BCCWITT will not release my personal information to any individual or organization except as outlined above, without my express consent in writing.

Date of submission

Date