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BCNA Walking Challenge and Online Wellbeing Workshop Registrations
*
1.
Full Name
(Required.)
2.
Postal Address (required for the distribution of the Walking challenge packs)
Street Address
City/Town
State
*
3.
Postcode
(Required.)
*
4.
Contact number
(Required.)
*
5.
Email
(Required.)
*
6.
What is your role with BCNA? (select all that apply)
(Required.)
Community Liaison
Support group leader
Support group member
Consumer Representative
Other (please specify)
7.
Support group name (if applicable)
*
8.
Are you happy for your contact details to be shared with other online workshop participants?
(Required.)
Yes
No
Contact number only
Email only
*
9.
Would you be interested in connecting with other participants through a closed Facebook group?
https://www.facebook.com/groups/BCNAwellbeingcommunity/
(Required.)
Yes
No
Maybe
I don't use Facebook, but would like to try
I don't want to use Facebook
*
10.
Which program are you registering for?
(Required.)
BCNA Walking Challenge
Online Wellbeing Workshop
Both
*
11.
Would you like a hardcopy of the Online Wellbeing Workshop workbook?
(Required.)
Yes
No, I am happy to use the workbook online
No, I will print one myself
No, I am not registering for the Online Wellbeing Workshop
