User Registration Form (Individual) This field is hidden when viewing the formAccount Type(Required) Individual Username(Required)Enter a username that will be used when logging in. This cannot be changed.Password(Required) Enter Password Confirm Password Strength indicator Contact InformationName(Required) First Middle Last E-mail Address(Required) Enter Email Confirm Email Phone Number(Required)Alternate Phone NumberWebsiteSocial Media AddressAddress(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code IdentityDo you identify as Japanese Canadian?(Required) Yes No Are you a Descendant?(Required) Yes No Are you a Survivor?(Required) Yes No In 300 words or less, describe your personal connection to the Japanese Canadian community. If applicable, describe the background of your family’s experience in Canada prior to and including 1942.(Required)Attestation(Required) By completing this registration form I declare that the information above is truthful and accurate to the best of my knowledge and belief.
