ON DEMAND COURSE: JEDI Part 1: It Starts With U

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1 Welcome

2 Price

3 People in your group

5 Please Tell Us A Bit About You...

Preferred name	Different than first name, what you are called or the name you go by. If you're joining us online, it's helpful if your registration matches your name on Zoom.
Pronouns	We invite you to share your pronouns with us during registration and again during the program. You can add your pronouns to you Zoom name.
Phone - Main
Address	This is where we will mail any tax receipts.
Address 2
City
State/Prov.
Zip/Postal
Country
Birth Date	A participant must be 19 or older to register for an adult program at The Haven
Terms and Conditions *	I accept the terms and conditions.View terms and conditions. Some online program sessions may be recorded. Audio and visual of participants will not be shared without prior consent.
Online access *	I have internet access and the minimum device configuration.This online program will be hosted using one or more virtual platforms. By checking this box, you confirm you have the minimum device requirements noted in the program description and reliable internet connection.
Email communications	Yes, I agree to receive additional resources, special offers, and occasional updates related to opportunities at The Haven.As part of your program registration, you will receive a few essential emails from us related to your experience. Beyond that, we hope you'll opt in to stay connected. You can unsubscribe at any time.
How did you hear about this program? *	The program leader's website, email, or social media Email from The Haven The Haven's Social Media A friend or family member The Haven's Website During another Haven program Doctor, counsellor or medical professional alive magazine article Please check all that apply and provide the name of the person referring you if this applies.

6 Donate to The Haven

7 Payment

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If you are registering someone other than the cardholder, please enter credit card number manually.

Due Now	$0 $0

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First Name
Last Name
Card Type
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card