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Green+Leaders Registration Form
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Date
*
Year
Year
2018
2019
2020
2021
2022
Month
Month
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Feb
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Day
Day
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Name
*
Position/Title
*
Primary Health Authority
*
Unit/Department
*
Unit Type
*
Operational
Clinical
Administrative
Other
Building
*
Address
*
Postal Code
*
Telephone #
*
Cell Phone #
*
Email Address
*
Supervisor/Manager Name
*
Position/Title
*
Supervisor/Manager Email Address
*
Where did you hear about the Green+Leaders Network?
*
Supervisor
Co-worker
GreenCare website
G+L Program Lead
GreenCare/G+L Lunch & Learn
Poster or notice
G+L E-Newsletter
Other G+L
Other
Why are you interested in joining the Green+Leaders Network?
*
What do you hope to gain from your involvement in the Green+Leaders Network?
*
What committees, associations or affiliated organizations do you belong to within your health authority, if any?
*
What impact do you hope to have as a Green+Leader in your workplace? What would success look like to you?
*
Which of the following areas are you most interested in learning and participating in as a Green+Leader?
*
Waste reduction (recycling, composting, reusing)
Safer chemicals & toxicity reduction
Energy conservation
Water conservation
Active & clean transportation
Workplace leadership & culture change initiatives
Climate resiliency & adaptation
If you have any further comments or questions, please feel free to share below.
