Region 5 OSAID Workshop Registration

School Information:

Basic School Information:

Name:
City/Town:
Full Telephone Number:

Does your school have an existing student group against impaired driving?

This could include an OSAID chapter or any group with a similar mandate.

Yes
No

If you answered 'Yes' to the previous question, what is the name of your group? How many students are in your group? What types of events or campaigns have you organized?

Staff Supervisor Information:

Basic Staff Supervisor Information:

Full Name:
Email Address:

Are you a staff advisor for an existing anti-impaired driving group?

This could include OSAID or a similar group.

Yes
No

How many students are you bringing to the Region 5 Workshop?

For 1-3 students, the workshop cost is $10/student. For 4-8 students, the workshop only costs $5/student.

Student Information:

Full Name:

Student 1
Student 2
Student 3
Student 4
Student 5
Student 6
Student 7
Student 8

Email Address:

Student 1
Student 2
Student 3
Student 4
Student 5
Student 6
Student 7
Student 8

Gender:

	Female	Male
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6
Student 7
Student 8

Grade:

	9	10	11	12/13
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6
Student 7
Student 8

OSAID Member:

Or a member of a similar group.

	Yes	No
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6
Student 7
Student 8

Additional Notes:

Food/environmental allergies, special considerations, other comments etc...

Student 1
Student 2
Student 3
Student 4
Student 5
Student 6
Student 7
Student 8

Payment and Transportation Information:

What is the total cost for registration?

Please bring your payment (cash or a cheque made out to Midland Secondary School are acceptable) to the sign-in table at the workshop on Wednesday March 23rd to confirm your participation. Staff supervisors do not need to pay a fee, but are requested to remain with their students for the whole day.

How do you plan to travel to the Region 5 Workshop?

Every school is asked to provide their own transportation to and from the regional workshop. Input your location and 1170 Highway 26, ON L0L 1X0 (Simcoe County District School Board) in Google Maps to get your directions! http://maps.google.ca/maps?ct=reset

Are you planning on sending delegates from your school to the National CYAID Conference at Sheridan College, Oakville on May 12th-15th? If so, would you be interested in being transported by a Region 5 bus?

Check out this link for more information about the National CYAID Conference hosted by OSAID this year: http://osaid.org/index.php/conferences.html

Plan to attend the National Conference and would like to stay updated about the Region 5 bus.
Plan to attend the National Conference but NOT interested in a Region 5 bus.
Do NOT plan to attend the National Conference this year.

PLEASE PRINT A COPY OF THIS REGISTRATION FORM FOR YOUR RECORDS. Do you have any questions or comments? Feel free to email region5@osaid.org with the subject "Region 5 Workshop" at any time for additional information.