REGISTER BELOW

for one of our Health Promotion Kingston programs or courses!

Program

Affiliation

Rank

Environment

Army Air Navy

First Name

To appear on certificate

Last Name

To appear on certificate

Preferred Name

If different from First Name

Primary E-mail

Program communications will be sent to this email

Home/Cell Number

Unit

UIC

*Not applicable if RMC N/O Cdt

Supervisor's Approval (if applicable)

Yes, I have received approval

*MANDATORY FOR MILITARY MEMBERS: Supervisor's approval is required for some courses. You must confirm that you have received approval that this will be your place of work at this time.

Supervisor's Rank and Name (first and last)

*MANDATORY FOR MILITARY MEMBERS. Not applicable if RMC N/O Cdt.

Supervisor's Email

*MANDATORY FOR MILITARY MEMBERS

As COVID restrictions have lifted, we ask for your cooperation in the event of program disruption. Should the program/training be postponed, due to circumstances beyond our control, we will aim to reschedule your program at a later date. Thank you for your understanding. We will confirm this with you and your supervisor as soon as we are aware of the situation.

I have read, acknowledged and understood this statement

How did you hear about this Program/Campaign/Challenge?

Do you require a French participant workbook?

Yes No

Special Requests

Privacy Notice

I confirm that I have read the PRIVACY NOTICE.

Consent agreement

By registering to this program or activity, I consent to the collection and use of my personal information as described in the privacy notice above.

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