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Call for Information & Support
13 11 20
Next Available May 29 at 9am
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13 11 20
Next Available May 29 at 9am
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Life Now wait list
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Life Now wait list
13 11 20
Next Available May 29 at 9am
"
*
" indicates required fields
Life Now wait list
Please select the course you would like to be waitlisted for:
*
Exercise
Meditation
Please select which Exercise course you would like to be waitlisted for:
*
BENTLEY Exercise: details TBC, commencing early August
BUNBURY Exercise: Mondays & Wednesdays, 12:30-1:30pm (1hr), 31 July - 23 October
COMO Exercise: Mondays & Wednesdays, 11:00am -12:00pm (1hr), 21 August - 13 November
FLOREAT Exercise: Tuesdays & Thursdays, 12:00pm -1:00pm (1hr), 1 August - 19 October
JOONDALUP Exercise: Tuesdays & Fridays, 10:00am -11:00am (1hr), 22 August - 10 November*
MANDURAH Exercise: Tuesdays & Thursdays, 2:00pm -3:00pm (1hr), 1 August - 19 October
MIDLAND Exercise: Tuesdays & Thursdays, 2:00pm -3:00pm (1hr), 22 August - 9 November
WILLAGEE Exercise: Tuesdays & Thursdays, 11:00am - 12:00pm (1hr), 22 August - 9 November
Please select which Meditation course you would like to be waitlisted for:
*
GERALDTON Meditation: Thursdays, 3:00pm-4:00pm (1hr), 3 August - 7 September
MANDURAH Meditation: Thursdays, 1:00pm-2:00pm (1hr), 3 August - 7 September
PADBURY Meditation: Mondays, 2:00pm-3:00pm (1hr), 31 July - 4 September
SHENTON PARK Meditation: Mondays, 10:00-11:00am (1hr), 31 July - 4 September
ONLINE Meditation: Wednesdays, 10:00am-11:00am (1hr), 2 August - 6 September
ONLINE Meditation: Fridays, 11:00am-12:00pm (1hr), 4 August - 8 September
Course Eligibility - Exercise
Q: Individuals with any of the following health conditions are not eligible to participate in the Life Now Exercise program:
*
I have read the health-related eligibility criteria and confirm that I am able to seek medical clearance to participate in the Exercise course
- Presence of an acute illness, in addition to the initial cancer diagnosis. - Any musculoskeletal, cardiovascular, or neurological disorder that could place the participant at risk of severe injury or illness resulting from the exercise (Excluding conditions/disorders that require exercise as part of their treatment). - Presence of bone metastases. - Presence of Myeloma Bone Disease. - Severe anaemia (Hb < 80 g/L for men and women). - Neutropenia. *People with bone metastases may now apply for the Life Now Exercise Joondalup course. Participants will be required to provide the Exercise Physiologist with a radiological scan which identifies the location of the bone metastases i.e. CT/PET/Bone scan.
Q: Before the course starts, it is essential that each participant completes the forms provided in the Exercise Participant Pack and attends an initial assessment with the Accredited Exercise Physiologist facilitating the course (fee applies).
*
I am aware of the pre-course requirements and can commit to completing them before the course commences.
Registrant Information
Name
*
Dr.
Miss
Mr.
Mrs.
Ms.
Mx.
Prof.
Rev.
Prefix
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
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Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
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Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
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United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
*
Phone
*
Date of Birth
*
DD slash MM slash YYYY
We ask for your date of birth to enable us to distinguish between participants of the same name.
What is the date of your diagnosis?
*
DD slash MM slash YYYY
What is your cancer type?
*
Emergency Contact
Name
*
First
Last
Relationship
*
Phone
*
How did you hear about our Life Now courses?
*
Please Choose
Cancer Council brochure or resource
Cancer Council email
Cancer Council staff or volunteer
Cancer Council website
Friend or relative
Health Professional
Internet search (e.g. Google)
Media (e.g. newspaper, radio)
Social media (e.g. Facebook)
Other (Please specify)
Privacy Policy
*
I understand that a member of the Life Now team will be in touch with me to discuss or confirm my application in accordance with the
Cancer Council WA Privacy Policy
.
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