You must have JavaScript enabled to use this form. Your Name First Name Last Name Telephone Email My Story Brief Story or Topic you are comfortable sharing My Relationship to Ontario Shores - Select -Currently receiving services from Ontario ShoresReceived services from Ontario Shores within the past two yearsFamily member of someone receiving services at Ontario ShoresNone of the above Intended Audience(s) Other Patients - Internal Other Patients - External School Students General Public Family Members Ontario Shores Staff Mass Media - TV/Radio/Print Ontario Shores Foundation - For Fundraising Purposes Size of audience I am comfortable with - Select -1-56-1212-2525-5050-200200+ Time Availability I will need support developing my presentation and story You may contact me to invite me to join committees at Ontario Shores Leave this field blank
