* - indicates required fields

General

First name: *
Last name: *
Email: *
Password: *
Password must be 10 or more characters long, contain at least one digit, one uppercase letter, one lowercase letter, one special character such as @#$%^&*&?!
Confirm Password: *

Membership

Partner Membership options:

- TEACHER - Registration as a teacher partner is free
- TIER 1 - Are you interested in sponsoring Co-operative Minds at the $500 level
- TIER 2 - Are you interested in sponsoring Co-operative Minds at the $1000 level
- TIER 3 - Are you interested in sponsoring Co-operative Minds at the $2000 level

Please note- Registration as a partner is free; once registered you will have the option of sponsoring the Co-operative Minds program for 1 year at the levels indicated above.

Address

Address
City
State / Province
Postal Code
Region *

Other

Grade and/or Course(s)
School Name
School Board
Organization Name
Website
Contact Person
Co-op Sector