Female Carers Retreat RSVP

Female Carers Retreat

21st to 22nd Febuary, at The Lavender Patch Mundaring
Let us know who you are*

First NameLast Name
Email*
example@example.com
My phone number*
Please enter a valid phone number.
The person or people with an NMC in my life that I care for are*
I am this person's*

MotherWife/partnerDaughterAdult sisterOther
If you know someone else registering you would like to share a room with, please let us know who they are
Please list any dietary requirements or allergies
Please share any medical conditions or health concerns you think we should be aware of
Emergency Contact*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.
I understand that I am registering my interest and this does not guarantee me a place at the retreat. I will be notified by email of the outcome.*

Yes, I understand
I give permission for myself/my family to be photographed at this or other Neuromuscular WA events. Photographs taken may be used for promotional materials on Neuromuscular WA's website, social media platforms and/or resources developed and may be shared with sponsors who have provided funding towards the program for use on their marketing collateral.*

Yes, I give consentNo, I do not give consent
As this document collects personal information, please read our Privacy Policy to understand how we will use and store this information.
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