Consent to Register V2

All information collected by this questionnaire is confidential and is used only for the purpose of providing services to you. The information is collected in accordance with Contact North BC’s Privacy Policy.

Name*
First Last
Address:*
Street Address City Province Postal Code
Telephone:*
e-Mail Address:*
Enter Email Confirm Email
Date of Birth:*
DD dash MM dash YYYY
Community*
By clicking Yes, I give Contact North BC consent to accept any terms and conditions on my behalf when creating such accounts;*
- Yes, I consent.
By clicking Yes, I give Contact North BC consent to access my account(s) to confirm completion of any courses and register me in more courses as agreed;*
- Yes, I consent.
By clicking Yes, I give Contact North BC consent to create accounts in my name and using my e-mail address for agreed upon education and training providers;*
- Yes, I consent.
By clicking Yes, I give Contact North BC consent to register me in agreed upon courses for such education and training providers;*
- Yes, I consent.
This consent remains in place for a period of two (2) years from the date of signing or until such time I revoke the consent in writing. Upon revoking the consent, I will immediately change the password on the account to prevent any further access.*
- Yes, I agree.
By clicking Yes, I signed this Contact North BC Consent Form by typing my name in CAPITAL LETTERS in the signature line.*
- Yes, I agree.
Signature:*
Date
DD dash MM dash YYYY

Cookie	Duration	Description
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.