Class Registration Name(Required) First Last Test Payment Test Payment - Registration will not be valid Test Amount Price: Phone(Required)Email(Required) Enter Email Confirm Email Mailing Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact InformationName(Required) First Last Phone(Required)Email(Required) Participant WaiverI understand that my participation in these classes is voluntary and at my own risk. I take responsibility for any activity I elect to participate in. I acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries including death, damages or loss regardless of severity which I may sustain as a result of participating in any and all activities connected with/associated with these classes. I agree to waive and relinquish all claims I may have as a result of participating in the program against Breast Cancer Action and all officers, agents, servants, employees and/or against the instructor or substitute teacher. I understand that any photography taken while participating in a class or related event may be used for promotional purposes by Breast Cancer Action. In the event of emergency, I authorize Breast Cancer Action and the instructor to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my immediate care. I have carefully read, fully understand and agree to the aforementioned. Further, to the best of my knowledge, the health information provided above is accurate. Personal information will be kept secure and confidential. I have read and agree to the terms above Class Selection Date of the WeekTimeClass NameVenueFormatInstructorStart and End Dates Monday5:00-6:00 pmStretch and StrengthLink ProvidedZOOMKim BoudreauMonday, January 15-December 16 Tuesday1:00-2:00 pmTeena's Book ClubTBCHybrid zoom/in PersonMarie-Louise DoyleTuesday, January 16-December 17 Wednesday5:00-6:00 pmRestorative YogaLink ProvidedZOOMKim BoudreauWednesday, January 17-December 18 Wednesday1:00-3:00Art ExpressionTBCIn personPolly ErskineWednesday, January 17-December 18 Friday9:30-10:30Nia Fitness Wellness LifestyleLink ProvidedZOOMBarbara CarriereFriday, January 19-December 20 ClassClass Selection(Required) Stretch and Strength - Monday Teena's Book Club - Tuesday Restorative Yoga - Wednesday Art Expression - Wednesday Nia Fitness Wellness Lifestyle - Friday NOTE: There is a "Select All" button at the bottom of the datesStretch and Strength(Required) Monday January 8, 2024 at 5:00pm Monday January 15, 2024 at 5:00pm Monday January 22, 2024 at 5:00pm Monday January 29, 2024 at 5:00pm Monday February 5, 2024 at 5:00pm Monday February 12, 2024 at 5:00pm Monday February 19, 2024 at 5:00pm Monday February 26, 2024 at 5:00pm Monday March 4, 2024 at 5:00pm Monday March 11, 2024 at 5:00pm Monday March 18, 2024 at 5:00pm Monday March 25, 2024 at 5:00pm Monday April 1, 2024 at 5:00pm Monday April 8, 2024 at 5:00pm Monday April 15, 2024 at 5:00pm Monday April 22, 2024 at 5:00pm Monday April 29, 2024 at 5:00pm Monday May 6, 2024 at 5:00pm Monday May 13, 2024 at 5:00pm Monday May 20, 2024 at 5:00pm Monday May 27, 2024 at 5:00pm Monday June 3, 2024 at 5:00pm Monday June 10, 2024 at 5:00pm Monday June 17, 2024 at 5:00pm Monday June 24, 2024 at 5:00pm Monday July 1, 2024 at 5:00pm Monday July 8, 2024 at 5:00pm Monday July 15, 2024 at 5:00pm Monday July 22, 2024 at 5:00pm Monday July 29, 2024 at 5:00pm Monday August 5, 2024 at 5:00pm Monday August 12, 2024 at 5:00pm Monday August 19, 2024 at 5:00pm Monday August 26, 2024 at 5:00pm Monday September 2, 2024 at 5:00pm Monday September 9, 2024 at 5:00pm Monday September 16, 2024 at 5:00pm Monday September 23, 2024 at 5:00pm Monday September 30, 2024 at 5:00pm Monday October 7, 2024 at 5:00pm Monday October 14, 2024 at 5:00pm Monday October 21, 2024 at 5:00pm Monday October 28, 2024 at 5:00pm Monday November 4, 2024 at 5:00pm Monday November 11, 2024 at 5:00pm Monday November 18, 2024 at 5:00pm Monday November 25, 2024 at 5:00pm Monday December 2, 2024 at 5:00pm Monday December 9, 2024 at 5:00pm Monday December 16, 2024 at 5:00pm Select AllTeena's Book Club(Required) Tuesday January 9, 2024 at 5:00pm Tuesday January 16, 2024 at 5:00pm Tuesday January 23, 2024 at 5:00pm Tuesday January 30, 2024 at 5:00pm Tuesday February 6, 2024 at 5:00pm Tuesday February 13, 2024 at 5:00pm Tuesday February 20, 2024 at 5:00pm Tuesday February 27, 2024 at 5:00pm Tuesday March 5, 2024 at 5:00pm Tuesday March 12, 2024 at 5:00pm Tuesday March 19, 2024 at 5:00pm Tuesday March 26, 2024 at 5:00pm Tuesday April 2, 2024 at 5:00pm Tuesday April 9, 2024 at 5:00pm Tuesday April 16, 2024 at 5:00pm Tuesday April 23, 2024 at 5:00pm Tuesday April 30, 2024 at 5:00pm Tuesday May 7, 2024 at 5:00pm Tuesday May 14, 2024 at 5:00pm Tuesday May 21, 2024 at 5:00pm Tuesday May 28, 2024 at 5:00pm Tuesday June 4, 2024 at 5:00pm Tuesday June 11, 2024 at 5:00pm Tuesday June 18, 2024 at 5:00pm Tuesday June 25, 2024 at 5:00pm Tuesday July 2, 2024 at 5:00pm Tuesday July 9, 2024 at 5:00pm Tuesday July 16, 2024 at 5:00pm Tuesday July 23, 2024 at 5:00pm Tuesday July 30, 2024 at 5:00pm Tuesday August 6, 2024 at 5:00pm Tuesday August 13, 2024 at 5:00pm Tuesday August 20, 2024 at 5:00pm Tuesday August 27, 2024 at 5:00pm Tuesday September 3, 2024 at 5:00pm Tuesday September 10, 2024 at 5:00pm Tuesday September 17, 2024 at 5:00pm Tuesday September 24, 2024 at 5:00pm Tuesday October 1, 2024 at 5:00pm Tuesday October 8, 2024 at 5:00pm Tuesday October 15, 2024 at 5:00pm Tuesday October 22, 2024 at 5:00pm Tuesday October 29, 2024 at 5:00pm Tuesday November 5, 2024 at 5:00pm Tuesday November 12, 2024 at 5:00pm Tuesday November 19, 2024 at 5:00pm Tuesday November 26, 2024 at 5:00pm Tuesday December 3, 2024 at 5:00pm Tuesday December 10, 2024 at 5:00pm Tuesday December 17, 2024 at 5:00pm Tuesday December 17, 2024 at 5:00pm Select AllRestorative Yoga(Required) Wednesday January 10, 2024 at 5:00pm Wednesday January 17, 2024 at 5:00pm Wednesday January 24, 2024 at 5:00pm Wednesday January 31, 2024 at 5:00pm Wednesday February 7, 2024 at 5:00pm Wednesday February 14, 2024 at 5:00pm Wednesday February 21, 2024 at 5:00pm Wednesday February 28, 2024 at 5:00pm Wednesday March 6, 2024 at 5:00pm Wednesday March 13, 2024 at 5:00pm Wednesday March 20, 2024 at 5:00pm Wednesday March 27, 2024 at 5:00pm Wednesday April 3, 2024 at 5:00pm Wednesday April 10, 2024 at 5:00pm Wednesday April 17, 2024 at 5:00pm Wednesday April 24, 2024 at 5:00pm Wednesday May 1, 2024 at 5:00pm Wednesday May 8, 2024 at 5:00pm Wednesday May 15, 2024 at 5:00pm Wednesday May 22, 2024 at 5:00pm Wednesday May 29, 2024 at 5:00pm Wednesday June 5, 2024 at 5:00pm Wednesday June 12, 2024 at 5:00pm Wednesday June 19, 2024 at 5:00pm Wednesday June 26, 2024 at 5:00pm Wednesday July 3, 2024 at 5:00pm Wednesday July 10, 2024 at 5:00pm Wednesday July 17, 2024 at 5:00pm Wednesday July 24, 2024 at 5:00pm Wednesday July 31, 2024 at 5:00pm Wednesday August 7, 2024 at 5:00pm Wednesday August 14, 2024 at 5:00pm Wednesday August 21, 2024 at 5:00pm Wednesday August 28, 2024 at 5:00pm Wednesday September 4, 2024 at 5:00pm Wednesday September 11, 2024 at 5:00pm Wednesday September 18, 2024 at 5:00pm Wednesday September 25, 2024 at 5:00pm Wednesday October 2, 2024 at 5:00pm Wednesday October 9, 2024 at 5:00pm Wednesday October 16, 2024 at 5:00pm Wednesday October 23, 2024 at 5:00pm Wednesday October 30, 2024 at 5:00pm Wednesday November 6, 2024 at 5:00pm Wednesday November 13, 2024 at 5:00pm Wednesday November 20, 2024 at 5:00pm Wednesday November 27, 2024 at 5:00pm Wednesday December 4, 2024 at 5:00pm Wednesday December 11, 2024 at 5:00pm Wednesday December 18, 2024 at 5:00pm Select AllArt Expression(Required) Wednesday January 10, 2024 at 1:00pm Wednesday January 17, 2024 at 1:00pm Wednesday January 24, 2024 at 1:00pm Wednesday January 31, 2024 at 1:00pm Wednesday February 7, 2024 at 1:00pm Wednesday February 14, 2024 at 1:00pm Wednesday February 21, 2024 at 1:00pm Wednesday February 28, 2024 at 1:00pm Wednesday March 6, 2024 at 1:00pm Wednesday March 13, 2024 at 1:00pm Wednesday March 20, 2024 at 1:00pm Wednesday March 27, 2024 at 1:00pm Wednesday April 3, 2024 at 1:00pm Wednesday April 10, 2024 at 1:00pm Wednesday April 17, 2024 at 1:00pm Wednesday April 24, 2024 at 1:00pm Wednesday May 1, 2024 at 1:00pm Wednesday May 8, 2024 at 1:00pm Wednesday May 15, 2024 at 1:00pm Wednesday May 22, 2024 at 1:00pm Wednesday May 29, 2024 at 1:00pm Wednesday June 5, 2024 at 1:00pm Wednesday June 12, 2024 at 1:00pm Wednesday June 19, 2024 at 1:00pm Wednesday June 26, 2024 at 1:00pm Wednesday July 3, 2024 at 1:00pm Wednesday July 10, 2024 at 1:00pm Wednesday July 17, 2024 at 1:00pm Wednesday July 24, 2024 at 1:00pm Wednesday July 31, 2024 at 1:00pm Wednesday August 7, 2024 at 1:00pm Wednesday August 14, 2024 at 1:00pm Wednesday August 21, 2024 at 1:00pm Wednesday August 28, 2024 at 1:00pm Wednesday September 4, 2024 at 1:00pm Wednesday September 11, 2024 at 1:00pm Wednesday September 18, 2024 at 1:00pm Wednesday September 25, 2024 at 1:00pm Wednesday October 2, 2024 at 1:00pm Wednesday October 9, 2024 at 1:00pm Wednesday October 16, 2024 at 1:00pm Wednesday October 23, 2024 at 1:00pm Wednesday October 30, 2024 at 1:00pm Wednesday November 6, 2024 at 1:00pm Wednesday November 13, 2024 at 1:00pm Wednesday November 20, 2024 at 1:00pm Wednesday November 27, 2024 at 1:00pm Wednesday December 4, 2024 at 1:00pm Wednesday December 11, 2024 at 1:00pm Wednesday December 18, 2024 at 1:00pm Select AllNia Fitness Wellness Lifestyle(Required) Friday January 12, 2024 at 9:30am Friday January 19, 2024 at 9:30am Friday January 26, 2024 at 9:30am Friday February 2, 2024 at 9:30am Friday February 9, 2024 at 9:30am Friday February 16, 2024 at 9:30am Friday February 23, 2024 at 9:30am Friday March 1, 2024 at 9:30am Friday March 8, 2024 at 9:30am Friday March 15, 2024 at 9:30am Friday March 22, 2024 at 9:30am Friday March 29, 2024 at 9:30am Friday April 5, 2024 at 9:30am Friday April 12, 2024 at 9:30am Friday April 19, 2024 at 9:30am Friday April 26, 2024 at 9:30am Friday May 3, 2024 at 9:30am Friday May 10, 2024 at 9:30am Friday May 17, 2024 at 9:30am Friday May 24, 2024 at 9:30am Friday May 31, 2024 at 9:30am Friday June 7, 2024 at 9:30am Friday June 14, 2024 at 9:30am Friday June 21, 2024 at 9:30am Friday June 28, 2024 at 9:30am Friday July 5, 2024 at 9:30am Friday July 12, 2024 at 9:30am Friday July 19, 2024 at 9:30am Friday July 26, 2024 at 9:30am Friday August 2, 2024 at 9:30am Friday August 9, 2024 at 9:30am Friday August 16, 2024 at 9:30am Friday August 23, 2024 at 9:30am Friday August 30, 2024 at 9:30am Friday September 6, 2024 at 9:30am Friday September 13, 2024 at 9:30am Friday September 20, 2024 at 9:30am Friday September 27, 2024 at 9:30am Friday October 4, 2024 at 9:30am Friday October 11, 2024 at 9:30am Friday October 18, 2024 at 9:30am Friday October 25, 2024 at 9:30am Friday November 1, 2024 at 9:30am Friday November 8, 2024 at 9:30am Friday November 15, 2024 at 9:30am Friday November 22, 2024 at 9:30am Friday November 29, 2024 at 9:30am Friday December 6, 2024 at 9:30am Friday December 13, 2024 at 9:30am Friday December 20, 2024 at 9:30am Select AllTotal Method of Payment Online Payment (Credit Card) eTransfer to [email protected] Credit Card by Phone Mailed Cheque Note: Your class registration is only valid once we receive your payment. After submitting this form, send a cheque to Breast Cancer Action, with the following address: 1130 St Emmanuel TerraceOttawa, OntarioK1C 2J7After submitting this form, send your eTransfer to : [email protected] Password: "fitness"Please have your credit card ready after submitting this form, and phone 613-736-5921Please make sure to read and agree to the waiver above View and sign waiver aboveCredit CardCard Details Cardholder Name