Registration / Change of Information

Peel Region Alumni Group Registration Form

Complete the online registration form below to indicate your interest in the different areas that have been proposed.

Please note that personal information collected will be used for the purpose of maintaining you as an active member of the Region of Peel's Alumni Group.

If you are a current Alumni Member and require to change your contact information please complete the online registration below and indicate that you are changing contact info.

Contact Information
	* = Mandatory
* Member Info:
Current Member Changing Information First Time Registration
Employee #:
* First Name:
* Last Name:
* Address:
* City	* Postal Code:
* Phone #: ex: 555-555-5555	Fax #:
* Email Address:
Preferred Method of Communication with the Region of Peel: Mail Phone Email Fax Alumni Website
* Do you Consent to the use of your Personal Information for the Purposes of the Region of Peel's Alumni Group? Yes No

General Information
Last job title held at Region:
Years of service with the Region:
Would you like to be part of the Alumni Group Executive Committee? Yes No
Would you like to be involved in any of the following future activities? (Check all that apply) Alumni Group Meeting Mentorship Program Participate in the United Way Campaign Volunteering Participate in the together we're better awards None of the Above Other:

Registration Notes
Non-disclosure of the Region of Peel's Information Personal information collected will be used for the purpose of maintaining you as an active member of the Region's of Peel's Alumni Group. Questions about this collection should be directed to the Employment Coordinator at 905-791-7800, ext. 4442. Review the Code of Conduct

Please note that personal information collected will be used for the purpose of maintaining you as an active member of the Region of Peel's Alumni Group

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Revised: Wednesday April 06 2011

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