Hamilton Family Health Team - Workshop Registration

WAITLIST - Menopause Series

by Hamilton Family Health Team

Registrant Information

^*First name

^*Last name

^*Primary phone

^*Email

Notifications will be sent to this address

^*Date of birth

Address

Apartment, Suite, etc.

City

^*Postal code

^*Do you have a family doctor?

Yes

^*Where did you hear about us?

Advertisement (online or print ad)

Hamilton Family Health Team website

Health professional (doctor, nurse, case manager)

Social media (Facebook, Instagram, X)

Word of mouth (friend, family member, colleague)

Other

Waitlist Information

^*How would you like to attend group workshops in the future?

In person

Virtually

Either / both

^*What time of day would you like to attend group workshops?

Morning

Afternoon

Evening

Anytime

^*I understand that the selections above are to assist with scheduling, but there is no guarantee that I will be matched with a program that meets these preferences.

YesNo

^*I understand by going on this waitlist, it will be my responsibility to sign up for the program/workshop when I receive the email that there is a new offering, and that a place will not be held for me.

YesNo

Consent

By submitting this form, I agree to send this personal information to ****, for the purpose of registering for ****. I have the authorization to send the information about any other people that may be included on this form (e.g., a client, parent, child).

I agree to these Terms and Conditions and Privacy Policy, which outline how this personal information is kept safe.