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JA - Northern and Eastern Ontario (General Form)
First Name
Last Name (Required)
*
Region (Required)
*
Bancroft
Belleville
Brighton
Carleton Place
Cobourg
Collingwood
Cornwall
Georgian Trails
Grey Bruce
Haliburton
Kingston
Lakefield
Lakeshore West
Lindsay / Kawartha Lakes
Muskoka
Napanee
North Bay
Pembrooke
Peterborough
Port Hope
Prescott-Russell
Quinte West
Renfrew County
Sault Ste Marie / Algoma
Stormont Dundas & Glengarry
Sudbury
Thunder Bay
Trenton
Street
City
Province
Postal Code
Country
Preferred Phone
Home
Work
Mobile
Other
Home Phone
Work Phone
*
Mobile Phone
Do Not Call
True
False
Email
*
I do NOT consent to email marketing.
*
True
False
Gender
Male
Female
Non-binary
Prefer not to identify
Volunteer Skills
World of Choices
Hall of Fame
Computer usage
Manual labor
Marketing
Fundraising
Event Planning
Language Spoken
English
French
Other
Preferred Delivery Language
English
français
Program of Interest
World Of Choices
Personal Finance
More Than Money
Be Entrepreneurial (BE)
Business Basics
Company Program (in school)
Dollars with Sense
Economics for Success
Not Sure
Our Business World
Trade and Technology
Our Community
Volunteer Availability
Morning
Afternoon
Full School Day
JA Alumni?
True
False