Registration Request

* indicates required fields

• First Name: *
• Last Name: *
• Employee ID: *
• Your Role: *
• Department: *
• Telephone: *
• Western Email Address: *
• Department Speedcode & Account (e.g. AB99 631800): *

• 
  (Used only if a Withdrawl Fee is charged)

• Below, please briefly describe your leadership role and list a few examples of the type of work priorities you manage:*

Please select the program you wish to attend based on the 2012-13 Schedule: *

• IP2
  May 8, 2013 9:00am - 12:00pm SSB 4210