First Name
Last Name
Full Home Mailing Address
Non-Board Email
Name as you’d like it to appear on the certificate
Home / Mobile Phone Number
Your School / Worksite
Please indicate the number of years you have been in the teaching profession, in any board, including part-time and occasional teaching. Pins will ONLY be awarded to members whose years of service MATCH one of the designated years below. They are not given retroactively.
Awards Celebration & Dinner RSVP
Ticket Type
Number of Complimentary Tickets
Number of Tickets Requiring Payment
Total Number of All Tickets
Total Amount Payable (If $0 type $0 – zero)
Seating Preference (You and Guest if applicable)
Further Seating Details If Required (i.e., Names of Colleagues, Guest,)
Acknowledgements
Dietary Requirements Including Those for Guest If Applicable (Type N/A if not attending the dinner)
Accommodations Including Those for Guest If Applicable Dietary Requirements Including Those for Guest If Applicable (Type N/A if not attending the dinner)
Self Identification
Racialized Person (Please Specify)
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