ILCNSW Assistive Technology on Tour Registration

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* 1. Event Location

Coffs Harbour (23 June 2015) - Cavanbah Centre, 191 Harbour Drive, Coffs Harbour

Armidale (25 June 2015) - Kent House Activities Room, 141 Faulkner Street, Armidale

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* 2. Please Enter Your Name

First Name

Last Name

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* 3. Your Role / Occupation:

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* 4. Number of Attendees

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* 5. If other people are attending with you, please add their names below:

Participant 1

Participant 2

Participant 3

Participant 4

Other

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* 6. Contact Number

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* 7. Email

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* 8. Special Considerations or Additional Notes (e.g. wheelchair access, hearing or vision requirements, etc.)

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* 9. Which focus talks are you interested in attending? (Please tick more than one if applicable)
The talks go for 45 minutes.

1- Out and About: Mobility Options (10.45am)

2- Caring for You: Self-Care Options (11.45am)

3- Connecting to the World: Communication Options (1pm)

4- Let's See: Vision Options (2pm)

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* 10. Please indicate if you would like to be added to the ILCNSW mailing list for email notification of future ILCNSW events.

Yes, I would like to be added to the ILCNSW mailing list.

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* 11. How did you hear about this event?

ILCNSW Website

Newsletter - Disability Group

Word of Mouth

Flyer

Social media (e.g. Facebook)

Other (please specify)

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* 1. Event Location

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* 2. Please Enter Your Name

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* 3. Your Role / Occupation:

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* 4. Number of Attendees

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* 5. If other people are attending with you, please add their names below:

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* 6. Contact Number

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* 7. Email

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* 8. Special Considerations or Additional Notes (e.g. wheelchair access, hearing or vision requirements, etc.)

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* 9. Which focus talks are you interested in attending? (Please tick more than one if applicable)The talks go for 45 minutes.

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* 10. Please indicate if you would like to be added to the ILCNSW mailing list for email notification of future ILCNSW events.

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* 11. How did you hear about this event?

* 9. Which focus talks are you interested in attending? (Please tick more than one if applicable)
The talks go for 45 minutes.