Cowichan Forward Membership Form

Join Cowichan Forward and help shape the future of the Cowichan Valley.

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Name *

First

Last

the (Not (Please

Email *

Phone

Optional

Address / Area *

Which best describes your connection to the Cowichan Valley?

• Long-term Resident (10+ years)
• Recent Resident (less than 10 years)
• Business Owner/Operator
• Student
• Commuter/Work in the Valley
• Other (Please specify)

Other

Please Specify

What are the top 3 issues or opportunities you believe Cowichan Forward should focus on?

• Affordable Housing
• Environmental Sustainability and Climate Action
• Transportation and Infrastructure
• Healthcare Access and Services
• Education and Youth Engagement
• Arts, Culture, and Recreation
• Social Equity and Inclusion
• Other (Please specify)

Other (Please specify)

What level of involvement are you interested in?

• Receive Updates Only
• Attend Public Meetings/Events
• Volunteer for Specific Projects
• Join a Working Committee
• Contribute Expertise/Skills

Comment or Message

Multiple Choice

• First Choice
• Second Choice
• Third Choice

On a scale of 1 (Not concerned) to 5 (Extremely concerned), how concerned are you about the long-term future of the Cowichan Valley?

Selected Value: 1

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