Peer Registration - Rural Mental Wellness Toolkit

Please pay your registration fee here to secure your spot for the next training.

Name(Required)

First Last

New Username(Required)

After this step, you will have a profile on the Rural Mental Wellness Toolkit

Password(Required)

Enter Password Confirm Password

Email(Required)

Phone(Required)

Billing Address(Required)

Street Address Address Line 2 City Province Postal Code

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Registration Fee

Price:

Payment Information

Card Details

Cardholder Name

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Phone

This field is for validation purposes and should be left unchanged.

Registration Fee