- StepsOut Registration Page

Just complete this form and click on "Submit My Registration" Button, and your account will be active immediately.

* I have read and understand the PARQ
* First Name:
* Last Name:
Address:
City:
Province:
Postal Code:
Registration ID:
Age:
Gender	Male Female
Group:
* Phone:
* E-Mail:
* Re-enter E-Mail:
* User name:
* Password:
* Re-enter Password:

How did you find out the Well U Program? (check all that apply)
	Posters
	UVIC Student Website
	Word of Mouth
	Media/Newspaper
	Other:
Cancel