Change Maker Registration Form | We Can BC Campaign

I PLEDGE TO:

Reflect on my own attitudes and behaviors, so as to support gender equality and non-violence

Speak out against violence against women and promote actions to end it

Encourage five others to join the We Can campaign

Commit myself to support the We Can campaign so that it becomes a broad social movement

Communicate back to We Can about the ways I am an active Change Maker in my life

Username: *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

First Name: *

Last Name: *

Address:

City, Province:

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Phone:

Gender:

Occupation:

Where did you hear about the "We Can" Campaign?:

Yes, please publish my name on the online list of Change Makers.

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