Wellspring Cancer Support : Register

Register Information
Create Your Fundraising Page
Go All In

Joining Team Canal Dragons & Hope Floats

I'd rather just register as an individual

Create Account
Already have an Account

Personal Details

First Name *

Last Name *

Alternate display name

Email Address *

Password*

Phone *

Date of birth *

Dietary Requirements

Shirt Size *

Postal Address *

Postal Address

Address Line 1 *

Address Line 2

City *

Postal Code *

Province *

Country *

Emergency Contact Details

Please provide us with an emergency contact

First Name *

Last Name *

Contact Number *

Relationship to you

Create a Fundraising Page

Customise your fundraising page using the options below.

Fundraising Target *

Add a personal image

Profile Image

Medical Conditions

Do you have any pre-existing medical conditions which might affect your ability to take part, or be relevant if treatment is needed?

Yes No

Terms & Conditions

I agree to the above Terms & Conditions *