SEIU Healthcare Survey
RequiredRequired Question(s)
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Workplace:

Required 2.

Mobile Number 

 

50 characters left.
Required 3.
Name of adults attending? (You are welcome to bring as many adults as you would like. Each adult must pay $20.00 in advance)
 

1000 characters left.
Required 4.
Payment options

Important Notes:

All payments must be submitted well before July 26, 2019.

Head office address is: 125 Mural St, Richmond Hill, ON L4B 1M4
 
If you are sending a cheque or money order to the head office please put it to the attention of Amy Le.
 
 If you are sending a e-transfer please send it to a.le@seiuhealthcare.ca using password SEIUHealthcare as one word no space. 
 
Please do not sent cash in the mail.
Cash payment dropped off at Mural Head office at reception desk
Mail cheque or money order to the Mural Head office
E-transfer money
  • Comment:

  • 500 characters left.
5.
Name and age of children attending?
(Ages 5-16) Maximum of 3 children.
 

350 characters left.
6.
Do you require bus transportation? If so, which location works best for you?
Yes, Mural Head office at 125 Mural St, Richmond Hill, ON L4B 1M4
Yes, Carpool Parking 401 and Hurontario at Hurontario St & ON-401 & Hurontario St, Mississauga, ON
No, I do not requre bus transportation
Required 7.
How many people require bus transportation?
1
2
3
4
5
6
7
8
9+
I do not require bus transportation
  • Comment:

  • 500 characters left.
8.
Do you or any of your guests have any food allergies or dietary restrictions?
 

350 characters left.
9.

Do you or any of your guests require any special accommodations?  


 

350 characters left.