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Question Title

* About You

Please provide your first and last name below
You are welcome to include your preferred name and/or pronouns, but this is not required.

First Name

Last Name

Preferred Name

Pronouns

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* At what email address would you like to be contacted?
Please check your junk email inbox if you do not receive a confirmation email within 5 business days of submitting this form.

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* Name of your organization/team

LIVE WORKSHOPS

Question Title

* Which live workshop(s) are you interested in scheduling?
Check all that apply:

Workshop 1
Maximizing Coach Potential through the Power of the Mental Triad (Mental Health/Illness/Performance)

Workshop 2
Powering Coach Wellness & Performance through Self-Care

Workshop 3
Promoting the Power of Mental Health through Coaching Practice

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* In what language would you like the workshop(s) to be delivered?
Our live workshops are available in English and French and are led by a member of our CCMHS Learning Facilitator team.

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* What time zone should be used when scheduling the workshops?

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* What date(s) and time(s) would you like to schedule the workshop(s)?
Please only fill out the date(s) and time(s) for the workshop(s) that you are requesting.
Ex: If you are interested in Workshop 1, indicate the date and time for this workshop and leave the fields blank for the other two.

Workshop 1

Date

Time

AM/PM

Workshop 2

Date

Time

AM/PM

Workshop 3

Date

Time

AM/PM

Question Title

* Optional: Please use the space below to indicate alternative dates and times that could work for each of the requested workshop(s)

Workshop 1

Workshop 2

Workshop 3

Question Title

* How many participants will be attending this workshop?
Please only indicate the number of participants for the workshop(s) you are requesting
*Maximum of 25 participants per workshop

Workshop 1

Workshop 2

Workshop 3

SELF-PACED WORKSHOPS

Question Title

* Which self-paced workshop bundle are you interested in purchasing?

Bundle A: Please check ONE box corresponding to the workshop that you are interested in (ex. 1, 2, OR 3)
Bundle B: Please check TWO boxes corresponding to the 2 workshops that you are interested in (ex. 1 and 2, 2 and 3, 1 and 3)
Bundle C: Please check all THREE boxes (ex. 1, 2, AND 3)

	Workshop 1	Workshop 2	Workshop 3
Bundle A: 1 WORKSHOP $99.00	Bundle A: 1 WORKSHOP $99.00 Workshop 1	Bundle A: 1 WORKSHOP $99.00 Workshop 2	Bundle A: 1 WORKSHOP $99.00 Workshop 3
Bundle B: 2 WORKSHOPS $159.00	Bundle B: 2 WORKSHOPS $159.00 Workshop 1	Bundle B: 2 WORKSHOPS $159.00 Workshop 2	Bundle B: 2 WORKSHOPS $159.00 Workshop 3
Bundle C: 3 WORKSHOPS $199.00	Bundle C: 3 WORKSHOPS $199.00 Workshop 1	Bundle C: 3 WORKSHOPS $199.00 Workshop 2	Bundle C: 3 WORKSHOPS $199.00 Workshop 3

Question Title

* How many participants are in your group?
Check one box:

15-30
(10% discount)

31-51
(15% discount)

51+
(20% discount)

ADDITIONAL NOTES

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* Please provide any additional notes in the space below

If you have questions, please contact:

JENNIFER MISURELLI, PhD(c), MPC, RSW
Director of Education and Outreach, CCMHS
education.outreach@ccmhs-ccsms.ca

The CCMHS respectfully recognizes and acknowledges the relationship that the First Nations, Inuit, and Métis
across Canada have with the land all Canadians live on and enjoy.

You can discover more about the land you live and learn on by visiting www.native-land.ca.

Question Title

* About YouPlease provide your first and last name belowYou are welcome to include your preferred name and/or pronouns, but this is not required.

Question Title

* At what email address would you like to be contacted? Please check your junk email inbox if you do not receive a confirmation email within 5 business days of submitting this form.

Question Title

* Name of your organization/team

Question Title

* Which live workshop(s) are you interested in scheduling? Check all that apply:

Question Title

* In what language would you like the workshop(s) to be delivered? Our live workshops are available in English and French and are led by a member of our CCMHS Learning Facilitator team.

Question Title

* What time zone should be used when scheduling the workshops?

Question Title

* What date(s) and time(s) would you like to schedule the workshop(s)?Please only fill out the date(s) and time(s) for the workshop(s) that you are requesting.Ex: If you are interested in Workshop 1, indicate the date and time for this workshop and leave the fields blank for the other two.

Question Title

* Optional: Please use the space below to indicate alternative dates and times that could work for each of the requested workshop(s)

Question Title

* How many participants will be attending this workshop?Please only indicate the number of participants for the workshop(s) you are requesting*Maximum of 25 participants per workshop

Question Title

Question Title

* How many participants are in your group?Check one box:

Question Title

* Please provide any additional notes in the space below

* About You

Please provide your first and last name below
You are welcome to include your preferred name and/or pronouns, but this is not required.

* At what email address would you like to be contacted?
Please check your junk email inbox if you do not receive a confirmation email within 5 business days of submitting this form.

* Which live workshop(s) are you interested in scheduling?
Check all that apply:

* In what language would you like the workshop(s) to be delivered?
Our live workshops are available in English and French and are led by a member of our CCMHS Learning Facilitator team.

* What date(s) and time(s) would you like to schedule the workshop(s)?
Please only fill out the date(s) and time(s) for the workshop(s) that you are requesting.
Ex: If you are interested in Workshop 1, indicate the date and time for this workshop and leave the fields blank for the other two.

* How many participants will be attending this workshop?
Please only indicate the number of participants for the workshop(s) you are requesting
*Maximum of 25 participants per workshop

* How many participants are in your group?
Check one box: