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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: Skincare & Cosmetics Online Workshop

Look Good Feel Better® workshops are oﬀered exclusively for those diagnosed with cancer to help manage any appearance-related eﬀects of cancer and treatment. Since 1992, the program has helped hundreds of thousands of women face cancer with conﬁdence. 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)

After your workshop, we will send you a complimentary kit of skincare products and colour cosmetics to help you practice the techniques you will learn. While we hope the products are to your personal preference, please note that as they are generously donated, we are unable to guarantee a perfect match. Please indicate below which shade is the closest match for you.

				Please Do Not Send Me A Kit

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. Which of the following appearance-related effects of cancer treatment are most concerning for you?

4. In which city are you receiving treatment?

5. 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.

Look Good Feel Better and the product manufacturers make no expressed or implied warranties or endorsements regarding these or any other products and cannot accept any liability or responsibility for any detrimental effects resulting from the use of the products.

I acknowledge the fore-mentioned information and advice.