Registration for Asserting My Rights Nelson, 29 October 2026
If you need support to fill out this form, please contact Jocelyn Samuelu by email Jocelyn.Samuelu@ccsDisabilityAction.org.nz or by phone on 027 320 7785.
Please tell us your first and last name.
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First Name
Last Name
What is the best way to contact you? Tick as many as you like.
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Email
Phone
Please tell us an email address we can send information to.
example@example.com
Please tell us a phone number we can contact you on.
Please enter a valid phone number.
Format: (000) 000-0000.
Is there anything we need to know about contacting you e.g. using the NZ Relay Service?
Are you a disabled person, or a deaf/Deaf person, or a person with an impairment?
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Yes
No
Are you a whānau member of a disabled person, or a deaf/Deaf person, or a person with an impairment?
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Yes
No
Do you live in the Hastings District?
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Yes
No
Do you have dietary requirements?
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Yes
No
Please tell us what your dietary requirements are.
Is transport a barrier to you attending the workshop?
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Yes
No
We will contact you to discuss transport options and support.
Do you need a NZ Sign Language (NZSL) interpreter?
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Yes
No
Please tell us what type of support you need during the workshop. Tick as many as you need.
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I don’t need any support during the workshop.
Someone to help me understand the conversations
A quiet space if I need a break
Someone to walk my service dog
Support to serve my food at lunchtime
I need support for personal care and will bring my own support person.
An interpreter for my first language
Tell us what language you use.
Tell us more if you need another type of support.
Is there anything else you want to tell us?
Would you like to be emailed a copy of your submission?
Yes
Submit
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