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PSCB In Good Company - Social Peer Group Expression of Interest
Yes. You’re ready to be In Good Company!
Thank you for your interest in joining
In Good Company
, our social peer group for people with physical disabilities.
Please note: the location of the Sydney-based peer group will be determined by the suburb most convenient to the majority of the group members.
Whether you have always lived with physical disability, or have recently acquired disability,
In Good Company
creates breathing space, where you can simply relax, be yourself and enjoy good company with others who truly understand your journey.
About YOU
The following questions will help us understand more about who you are, what you're hoping to gain from our group and how you might contribute to our collective growth. We are very much looking forward to getting to know you!
Note: PDCN greatly values your privacy. The information you provide here will be kept confidential and used to help us select the peer group members for
In Good Company
, as spaces are limited.
For more information, our Privacy Policy is available on our website; https://www.pdcnsw.org.au/privacy-policy/
Let’s get started!
Contact Information
*
1.
First Name:
(Required.)
*
2.
Last Name:
(Required.)
*
3.
Phone Number:
(Required.)
*
4.
Email Address:
(Required.)
*
5.
Confirm email Address:
(Required.)
*
6.
Suburb:
(Required.)
*
7.
Postcode:
(Required.)
*
8.
Gender:
(Required.)
Female
Male
Other
Prefer Not To Say
*
9.
Age Group:
(Required.)
10-19
20-29
30-39
40-49
50-59
60-69
Over 70
*
10.
I identify as:
(Required.)
CALD
ATSI
LGBTQIA+
Regional/Remote
None of the above
*
11.
I have Physical Disability
(Required.)
Yes
No
Please specify
*
12.
I have non-physical Disabilities
(Required.)
Yes
No
Please specify
*
13.
To get around Sydney I:
(Required.)
Drive myself
Am driven by my support worker/informal support
Take Public Transport
Require/Prefer Wheelchair accessible taxis
Other
Please specify
*
14.
Which days/times would work best for you to attend monthly meetings? (Select all that apply)
(Required.)
Weekday Mornings
Weekday afternoons
Weekday evenings
All the above
*
15.
In Good Company will grow stronger with regular participation. We’d love to know your capacity to attend monthly meetings:
(Required.)
Yes, I can Commit to regular attendance
I can attend most meetings but may occasionally miss some
My schedule is unpredictable, but I'll try my best
I'm not sure at this time
*
16.
Preferred contact method:
(Required.)
Email
Phone
Text
Any of the above
*
17.
I get to socialise in person:
(Required.)
Every day
2-3 times per week
Once a week
Once a month
Less than once a month
Tell us more if you like:
*
18.
I am happy with the amount of socialising I have in my life:
(Required.)
Yes
No
Depends
Tell us more if you like:
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