User Training and Fit Testing Clinic Registration Form

*Which session will you attend?

*Your first name:

*Your last name:

*Your Title:

*Your Department:

*Facility/Company Name:

*Facility/Company Mail Address:

Facility/Company Address 2:

*Facility/Company City:

*Facility/Company Province: Select a province Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon

*Facility/Company Postal Code:

*Phone Number (numbers only. No dashes):

Fax Number (numbers only. No dashes):

*Your e-mail address:

*Retype your e-mail address:

The information you submit will be kept and used by 3M Canada to respond to your request. For further information on how 3M respects your privacy, visit our Privacy Policy and Privacy Code.

* I consent to such use by 3M Canada.