Carrying The Fire Community Workshop EOI Form

Southern Edge Arts

Carrying the Fire - Workshop Registration Form.
PARTICIPANT ENROLMENT DETAILS
Community Group Name
Main Contact Name*

First NameLast Name
Main Contact Email
example@example.com
Main Contact Mobile
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Emergency Contact Name

First NameLast Name
Alternative Emergency Contact Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Community Group Lantern Workshop - for up to 20 participants of any age to be held at the venue of your choice or Southern Edge ArtsPop up Lantern Workshop at your community eventProfessional Development Workshop for Teachers and Community Facilitators - to prepare you to lead your own group in the projectI'm not sure - can you please contact me to discuss
Estimated number of attendees.
YesNo
if Yes, Address of venue

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2 x 45 min workshopor 1 x 2 hours workshop
Is there a particular day & time that your club meets that you would like to have the workshop/s?
Children Under 12 yearsYoung People (12 - 17)AdultsMixed Age Group (Children under 6 will require adult assistance)
Access and Inclusion: Do you or your community group have any special requirements or needs?
I consent
Form Submitted by

First NameLast Name
YesNo
Have a question about the Lantern Workshops?

Contact Southern Edge Arts Carrying the Fire team on 0493 717 689 or ctf@southernedge.org.au.
Date Signed*

MonthDayYear
Date
Should be Empty:

Southern Edge Arts

PARTICIPANT ENROLMENT DETAILS