SCR Course Registration

Title
MrMrsMsMiss
Other (please specify)

First Name (required)

Surname (required)

Email (required)

Address

Suburb

Postcode

Phone
Home:
Mobile:

Which training are you registering to attend? (Select training and date of workshop if available. More than one workshop can be selected.)
Self-Advocacy Date:
Consumer Representation Date:
Co-facilitation Date:
Understanding the NDIS for Peer Workers Date:

Have you completed any advocacy or representation training before?
YesNo

If yes, please specify the organisation who provided this training and the date is was undertaken.

Do you have any dietary requirements?
YesNo
Please specify:

Do you have any additional needs? (e.g. wheelchair accessibility, electronic course materials etc.)

Will a support person be attending training with you?
YesNo
If yes, please provide their name and any dietary requirements they have:

Please explain why you want to attend the above training.

How did you hear about this course?

Thank you for completing this registration form. After submitting it, we will confirm you place as soon as possible.