Waterloo Wellington Self-Management Program
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Live life to the fullest with your ongoing health condition
 

Leader Contact Information Update Form

 

Please complete the following form below to ensure that our records are up to date with your most recent contact information and workshop availability. If you have any questions or concerns or simply need clarification, please feel free to reach out to Justine [email protected].

 

 

Leader Mailing Address Update

* First Name
* Last Name
* Phone Number
* Address
Unit/Suite
* City
* Postal Code
* Availability
Please list the days of the week you are available to lead workshops as well as the time of day that best suits your schedule (example: Monday- Morning, Afternoon or Evening)
 
 
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