Workshop Applicants
*
indicates required
Name:
Email:
Comment:
Email Address
*
First Name
Last Name
Workshop Name
ABN
Preferred Name
Pronoun
Preferred Days and time slots (please list 3)
have you run this workshop before, if so where?
Medical information that may be required
Your Emergency Contact: First name
Your Emergency Contact: Surname
Your Emergency Contact: Phone
Referee (know more than 12 month professional cap.
referee first name
referee last name
referee Phone
Dietary Requirements
*
Number of Participants
*