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* 1. Full Name

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* 2. Postal Address (required for the distribution of the Walking challenge packs)

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* 3. Postcode

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* 4. Contact number

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* 5. Email

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* 6. What is your role with BCNA? (select all that apply)

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* 7. Support group name (if applicable)

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* 8. Are you happy for your contact details to be  shared with other online workshop participants?

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* 9. Would you be interested in connecting with other participants through a closed Facebook group?

https://www.facebook.com/groups/BCNAwellbeingcommunity/

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* 10. Which program are you registering for?

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* 11. Would you like a hardcopy of the Online Wellbeing Workshop workbook?

T