Manitoba in motion

Workplace Registration Form

Name of Workplace:

Community:

Contact Person:

E-mail:

Address:

City/Town:

Postal Code:

Phone Number:

Fax Number:

Number of employees:

1-10 11-25 26-100 101-250 over 250

Please list your Workplaces in motion Leaders(s).

Name	Position	Phone	E-mail

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