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 Date Format: 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?YesNoHave you attended a support group in the past?YesNoHow 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 StressNot interestedInterestedVery interestedSelf‐AwarenessNot interestedInterestedVery interestedSetting GoalsNot interestedInterestedVery interestedThe Cycle of AbuseNot interestedInterestedVery interestedSpotting An AbuserNot interestedInterestedVery interestedStages of ChangeNot interestedInterestedVery interestedCommunicationNot interestedInterestedVery interestedConflict ResolutionNot interestedInterestedVery interestedBoundariesNot interestedInterestedVery interestedRelapsesNot interestedInterestedVery interestedSafety PlanningNot interestedInterestedVery interestedTriggersNot interestedInterestedVery interestedAnger ManagementNot interestedInterestedVery interestedSelf-EsteemNot interestedInterestedVery interestedArtistic ExpressionNot interestedInterestedVery interestedAre there any other topics not listed here you would like to explore?Do you have any other comments, questions or concerns?