Clone of H&W Template Workshop Registration Form

Healing Circles Registration Form
Thank you for registering for the Healing Circles for Survivors of Intimate Partner Violence. The program will take place on November 9, 16, 23 and 30. from 6:30 to 8:30 (please arrive 15 minutes earlier) at the North Shore Women's Centre, 131 East 2nd Street, North Vancouver.

For more information, you can reach us at 604-973-2508 or golnaz@northshorewomen.ca
Full Name

First NameLast Name
Where do you reside? (this is asked to keep track of the demographics we serve)

Other
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Do you need childminding for these sessions
Number of kids attending and their age
Any special requirements for the kids
Should be Empty:

Healing Circles Registration Form