Personal Support Network Facilitation: October 2nd to November 12th, 2023

Personal Information

• * First Name:
• * Last Name:
• * Phone:
• * Email Address:
• * Confirm Email Address:
• * City:
• * Province:
• * Country: --Choose-- United States Canada -------------- Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Cote D'Ivoire Croatia Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guyana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
• Organization (if applicable)
• If you work for an organization what is your role/position?

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  1 Seat	$300.00 CAD
  5 Seats (Buy 4 Get 1 Free!)**	$1,200.00 CAD

• *

  How did you hear about this course? (select all that apply):

  • Facebook
  • Twitter
  • Instagram
  • Plan Institute / RDSP.com website
  • Plan Institute's workshop / webinar
  • Plan Institute's newsletter
  • From another organization / professional
  • Search engine / Online lookup
  • Referred by someone
  • Plan Institute's disability planning helpline
  • Other (please specify):
• If you selected "Other" to the question above please explain here:
• *

  I identify as a...

  • Person with a disability
  • Parent or legal guardian of a person with a disability
  • Sibling of a person with a disability
  • Grandparent of a person with a disability
  • Other family member / Friend / Caregiver / Support person
  • Professional (health care, financial, legal, social worker, etc.)
  • Other (please specify):
• If you selected "Other" to the question above please explain here:
• *

  What is the age of the person with a disability that brings you to this course? If attending for yourself, what is your age? (select all that apply if you are here for multiple people):

  • 18 or under
  • 19-29
  • 30-49
  • 50-59
  • 60+
  • Prefer not to answer

Click 'Add' to include Additional Learner

• Please ensure that you enter the names and email addresses for all 5 learners in your group. After you've finished adding the first Learner, click "Add Another", until all 5 have been added.

You may add a maximum of 5