Submit

helping people with cancer | pour aider les personnes atteintes du cancer

WORKSHOP PARTICIPANT REGISTRATION/RELEASE FORM

Thank you. You are registering for our online live workshop: Post-Treatment Nutrition

Look Good Feel Better® workshops are oﬀered exclusively for those diagnosed with cancer to help them feel more like themselves again. We sincerely hope you have a meaningful experience. An email conﬁrmation will be sent to you once this form has been completed.

Please complete the following:

First Name

Last Name

Canada Post Address Lookup (Try it out—type a Postal Code, street or address)

Example:

Street No.

Street Name

Suite / Apt.#

City

Province e.g. ON (Do Not Edit)

Postal Code

E-mail Address

Telephone (a text reminder for your workshop will be sent to this number)

Workshop Type

Workshop Session. (Please Confirm The Date and Time Below - Time listed in Eastern Standard Time)

A few helpful questions to ensure we meet your needs and reach more people.

1. How did you hear about the Look Good Feel Better workshop?

2. Age

3. In which city are you receiving treatment?

4. At which hospital?

Stay connected with us for more valuable tips and important information for you. Make sure you check the box below to receive our monthly e-newsletter and to learn of new workshops and special events. We respect your privacy and will protect your personal information in adherence with all legislative requirements. We do not rent, sell or trade our mailing list.

Yes, please keep me updated on Look Good Feel Better program offerings, newsletters and campaigns.

If at any time you wish to be removed from our list, simply contact us at 1-800-914-5665 or via email at news@lgfb.ca

The workshop is complimentary to you and made possible by donations from the charity's corporate, community and individual donors and our volunteers.

The workshop is not intended to replace medical care or attention in any way.

To respect the privacy of attendees and volunteers, screen shots, photography or recording is not permitted.

I acknowledge the fore-mentioned information and advice.