Women’s Program Registration Choose SessionWinterSpringSummerFallPersonal InformationName First Last PhoneAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date of Birth MM slash DD slash YYYY Email Enter Email Confirm Email Health InformationAny allergies, asthma, medical concerns or dietary restrictions we should be aware of?Will you require child care? Yes No Have you attended a support group in the past? Yes No How did you hear about this group?What would you like to gain form this group?Topics of Interest Please fill out this quick survey to help us know the topics you’re most interested in for our group discussions.Tools and Techniques for Managing Emotional Stress Not interested Interested Very interested Self‐Awareness Not interested Interested Very interested Setting Goals Not interested Interested Very interested The Cycle of Abuse Not interested Interested Very interested Spotting An Abuser Not interested Interested Very interested Stages of Change Not interested Interested Very interested Communication Not interested Interested Very interested Conflict Resolution Not interested Interested Very interested Boundaries Not interested Interested Very interested Relapses Not interested Interested Very interested Safety Planning Not interested Interested Very interested Triggers Not interested Interested Very interested Anger Management Not interested Interested Very interested Self-Esteem Not interested Interested Very interested Artistic Expression Not interested Interested Very interested Are there any other topics not listed here you would like to explore?Do you have any other comments, questions or concerns?