2017-18 Participant Questionnaire

  • This should be the email you want to use to receive communication from Leadership Victoria.
  • Please provide a backup phone # and indicate if this is home, work, or cell phone.
  • Who should we contact in case of emergency at the retreat, learning days, or other LV events? (Name)
  • Cell phone preferred!
  • We use caterers to provide most of the food for our functions. Please indicate any dietary restrictions or allergies that should be passed on to our caterers.
  • Is there any other information that our team should know about to keep you safe and healthy while participating in Leadership Victoria functions? This will be provided to event leads.
  • Orientation is your opportunity to meet your fellow participants and many of the volunteers who make this program work. We will be giving you pre-retreat assignments and explaining what to expect from the year ahead.
  • We'll be going to the Cowichan Lake Outdoor Education Centre for our leadership retreat, Sept 22-24. Please make a note here if you are able to provide a ride for a fellow participant, or would like us to connect you with someone who's able to offer a ride.
  • Please upload a "profile picture" of yourself. This should be something that we can include in a package for participants and our program team to help with remembering names. It should show your face clearly. Maximum size 3MB.
    Accepted file types: jpg, gif, png.
  • Share a quote with us that inspires you as a community leader. This will be posted with your profile picture at the start of the retreat to help everyone get to know each other.
  • Please provide a short bio to help your fellow participants get to know you better. Where do you work, what's your educational/work background, and what do you like to do in the community?
  • Please check off four topic areas (or less). This information informs our program team as we put together Community Action Project groups.
  • This field is for validation purposes and should be left unchanged.