Registration of InterestPlease complete and return this form to register your interest in our program for Term 1 2020.First Name*Last Name*Date of Birth*Street Address*City*State*Postcode*Phone*Email*If under 18 years of age please provide carer / guardian / parent detailsEmergency contact person*Do you have a support worker / companion who will attend sessions with you?*YesNoPlease tell us about your needs / requirementsWhat type of writing do you enjoy?What would you like to learn at Spectrum Writing?Please tick the options you’re interested in:*WorkshopsMentoringWriting Social GroupDungeons and Dragons Social GroupPreferred Location*SouthNorthCity CentreOnline GroupPreferred contact optionEmailTextPhoneHow did you hear of us?*Social mediaGoogleWord of mouthOtherWe will be in contact with each participant prior to enrolment to discuss individual requirements.Send Error occured. Please confirm your data and submit again: Contact Us We’d love to hear from you. Phone: 0407 520 503 Name Email Address Message 9 + 7 = Send Web design & hosting by Powdermonkey Design
