PACE 2000 General Registration and Involvement Questionnaire cliquez ici pour le formulaire en français	Click here for address details and a location map Registration Viewer
Welcome to the PACE 2000 registration page. If you are interested in registering for one of our programs, volunteering or just making contact to get further information about PACE 2000, please fill out this form and then click on the 'Submit' button to send this information to us.

	Required Contact Information
	First Name:	*		'*'  required.
	Middle Name :
	Last Name:	*
	Phone Number :	(1)		(1) Please enter a phone number and/or your Email address so we can contact you.
	Email Address :	(1)
				or continue on this form
	If applicable, please indicate your ...
	Organization, School or Company :
	Occupation :
		.
	Thank you for completing this basic registration information please continue to our involvement questionnaire below. If you have worked with PACE 2000 in the past please click here to jump to "Past Involvement" section of this questionnaire
	Optional Contact Information Please help us complete our records by completing the optional information below
	Address1 :
	Address2 :
	City :
	Province/State :
	Postal/Zip Code :
	Country :
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	Optional Information
	What are your goals with respect to your involvement with PACE 2000?
			to interact with young persons
			to interact with seniors
			to participate in the Inter-generational Virtual Village
	to receive coaching in PACE 2000's programs and activities:
		Please specify:
			PACE-2-Face (TM) Tele-Mentoring, one-on-one videoconferencing
			PACE 2000 Group Mode, group videoconferencing (no UserID or password required)
			PACE 2000 telehealth activities
			I need more information on PACE 2000's programs and activities
	to provide coaching in PACE 2000's programs and activities:
		Please specify:
			PACE-2-Face (TM) Tele-Mentoring, one-on-one videoconferencing
			PACE 2000 Group Mode, group videoconferencing (no UserID or password required)
			PACE 2000 telehealth activities
			to become a mentor to isolated youth and seniors
	Other
	If you selected 'Other', please describe the service(s) you could provide or receive.
	I need more information on PACE 2000's programs and activities
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	If you have been associated with PACE 2000 in the past, please indicate the manner in which you participated:
			Participant in inter-generational programs (youth and seniors)
			Inter-generational coordinator (youth)
			Mentor to youth
			Mentor to senior
			Clerical support
			Technical support
			Consulting expert
			Other
	If you selected 'Other', please describe the manner in which you participated.
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	Are you interested in joining PACE 2000 as a volunteer?
	If yes, please indicate your areas of interest.
			Inter-generational Coordinator (Senior or Youth)
			Mentor (Senior or Youth)
			Administrative support
			Technical support
			Research assistant
			Other
	If you selected 'Other', please describe the service(s) you could provide.
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	How did you learn about PACE 2000?
			Internet search
			Link from a web site
			Conference participation
			Other
	please indicate web site(s) or conference information.
	Thank you for your interest in the PACE 2000 Inter-generational Virtual Village!
	We will contact you within the coming month to plan your participation in the activities of your choice.
			I need to be contacted in the coming days
			I don't need to be contacted
	To go to Submit Page, click on the 'Continue' button.