Carers and Seniors Rock & Roll Matinee RSVP Form

SHIRE OF GINGIN

PO Box 510, Gingin WA 6503

mail@gingin.wa.gov.au

www.gingin.wa.gov.au

08 9575 5100
RSVP

Please let us know if you will be able to attend our Carers' and Seniors' Rock & Roll Matinee on Wednesday 12 November!
Full Name

First NameLast Name
Phone Number
E-mail
example@example.com
Suburb
Where in the Shire of Gingin do you reside?
I am attending as a...

CarerSenior
Carer: People who provide unpaid care and support to family members and friends who have a disability, mental health condition, chronic condition, terminal illness, an alcohol or other drug issue or who are frail aged.

Senior: People over the age of 65.

TRANSPORTATION

Free transportation is provided by the Shire of Gingin and Lancelin CRC with pick up/drop off locations within the Shire.
Do you require pick up and drop off transportation?*

YesNo
Transportation bookings will be taken over the phone.

Please contact the Shire of Gingin on 08 9575 5150 to book transport.

Please note, there are limited bus seats available. Bookings will only be taken for those requiring to be both picked up and dropped off.

DIETARIES

We will do our best to cater to all dietary requirements we are alerted of.
What dietary requirement do you have?*

No dietary requirementVegetarianVeganLactose-IntolerantGluten-IntolerantOther
Should be Empty:

RSVP