Workshop Attendee's Information

Name *

Surname *

Address (Street No & Name) *

Suburb *

State *

Postcode *

Contact Phone Number *

Email *

Funding

Please select *

Privately fundedNDIS funded

If you are a current client of Family Connections Sydney, please complete the NDIS Participants name below only (additional NDIS plan details are not required as we will already have them on file).

NDIS participant's name: *

NDIS participant's number

Plan start date

Plan end date:

Plan is:

Self-managedPlan managedNDIA managed

Plan Manager's Name: *

The participants contact details are the same as those previously stated above.

NDIS participant's address:

Suburb:

State:

Postcode:

Completed by

Form completed by *

I confirm that above information I have provided is true, complete and accurate. *

Signed *

Clear

Today's Date *

Thank you for taking the time to provide us with this information. The information collected is for the purpose of registering for an upcoming workshop presented by Family Connections Sydney.

All data collected by Family Connections Sydney is kept in accordance with the Australian Privacy Act 1988 which protects the handling of personal information about individuals. This includes the collection, use, storage and disclosure of personal information.

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