Registration Form
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Phone Number
*
E-mail
*
example@example.com
Age Group:
*
0-5
6-12
13-17
18-64
65+
Gender:
*
Man
Woman
Non-binary
Prefer not to disclose
Ethnicity:
*
ie. Nigerian, Cameroon etc.
Are you a student? If so, what is your current level of education?
I'm interested in...
African/Caribbean Groceries
Fruits and Vegetables
Hot Meals
Computer Tablet
One-on-one Tablet Orientation
Zoom Classes
Submit
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