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* (Please use capital letters and a space in the middle.)
Home phone* Are you a TTOC?	E-mail address* This is my personal e-mail This is my work e-mail
School phone	School name
I am registering for LWB in this city:
My school district

Members are generally required to attend Living with Balance workshops within their own school district. You will be registered in the workshop specified in the above drop down list.

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