Parkinson’s South Georgian Bay, Living Better With Parkinson’s Fitness & Wellness Program Registration Form Name:(Required) First Last Address: Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone:Mobile Phone:Business Phone:Email Address:(Required) Emergency Contact Name:Emergency Contact Phone:Select Program:SelectPWR Moves $50Mindfulness Meditation $0Dancing with Parkinsons $60Sitting/Standing Yoga $0Postural Training $40Payment Method: eTransfer to info@livingbetterwithparkinsons.ca Mail in cheque Please send e-transfers to info@livingbetterwithparkinsons.caMail in cheques can be mailed to: Parkinson South Georgian Bay also known as Living Better with Parkinson’s Care of The Collingwood Foundry 64 Hurontario St, Suite #160 Collingwood, Ontario L9Y 2L6
