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2. Last Name*
3. First Name*
5. Email*
6. Phone Number*
8. Select how you plan to attend the event.*

   1. In Person at Wetaskiwin AG Society
   2. Online (virtual link will be sent 1 week prior to event)
9. Are you a County of Wetaskiwin Resident?*

   1. Yes
   2. No
11. Freedom of Information and Protection of Privacy Act

    The personal information collected through this Understanding Dementia and Alzheimer Disease Workshop for the sole purpose of registering for Understanding Dementia and Alzheimer Disease Workshop. This collection is authorized by Section 4(c) of the Protection of Privacy Act (POPA). For questions about the collection of personal information, please contact the County of Wetaskiwin Privacy Officer: email legislativeservices@county10.ca; telephone 780.352.3321; in person at 243019A Hwy 13, or send post mail to County of Wetaskiwin No. 10, Box 6960, Wetaskiwin AB, T9A 2G5.

13. 
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

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