Registration of Interest Form
Saturdays in Ballina (fortnightly)
$80/session
Full Name
*
NDIS Number
*
Please put N/A if not applicable
Contact Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date of Birth
/
Month
/
Day
Year
Date
NDIS Plan Manager
*
Plan Manager Details for Invoicing
*
Email/Phone Number
Do you require a support worker for our sessions? If yes, please specify whether you will be bringing your own support worker or if you would like us to provide support for you (PLEASE NOTE: This will be invoiced as an additional charge, charged hourly as per NDIS guidelines)
*
How did you hear about us?
*
Social Media, Friend/Colleague, Flyers etc
Would you like to stay up to date with future workshops we hold?
*
Sun St. Clay will be taking a few photos during our sessions to help promote our workshops on our social media. Do you consent to your photo being used to help promote our business?
*
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