Living with Balance program registration form

Your personal information is collected and used by the BCTF for the purpose of administering the Living with Balance Program. The BCTF and group leader share your name, e-mail address, and telephone number for registration purposes. Please be aware that this information will be shared with the facilitator and/or the local president. For more information about our privacy practices, please see the BCTF Privacy Policy.

*Required field.

Name*
Address*
City*	Province	Postal code*
Home phone*	E-mail address* This is my personal e-mail This is my work e-mail
School phone*	School name:
Local*
School district
Preferred session location*