Flash Fiction Workshop Registration (Youth)

For ages 12-17 years

Thursday 15 July 2021

2pm - 4pm

Rockingham Youth Centre, 20 MacKinnon St, Rockingham 6168

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Contact Information

Address

Address 2

City/Town

Post Code

Email Address

Phone Number

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* 4. Emergency contact details

Name

Phone Number

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* 5. Do you have any dietary, access or support requirements?

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* 6. How would you describe your gender?

Female

Male

Other

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* 7. How did you hear about this workshop?

Facebook

Instagram

City of Rockingham website

Word of mouth

Other (please specify)