REGISTRATION FORM FOR SOCIAL EVENTS
IF YOU ALREADY GAVE US INFORMATION BEFORE (eg NDIS number, emergency etc), PLEASE IGNORE THE QUESTIONS.
First Name
*
Last Name
*
SMS number
Email Address
*
Which event do you want to go to? You can choose more than one.
*
Craft Mosaic - 14th February - $5
Craft Metal Stamping - 7th March - $20
Craft Tye Dye - 4th April - cost announced soon
Craft Mosaic - 9th May - $5
Craft Paper Making - 6th June - $15
Craft Christmas in July - 25th July - $15
Craft Resin - 22nd August - cost announced soon
Craft Xmas Mosaic - 26th September - $5
Craft Xmas Mosaic - 24th October - $5
Craft Xmas Mosaic - 14th November - $5
Craft Christmas and Break Up Lunch - 5th December - $15 (free lunch)
Lunch Club 21st March at Fasta Pasta, South Terrace, Adelaide
Lunch Club 2nd May at Caffe Brunelli, Rundle Street, Adelaide
Lunch Club 30th May at Goodwood Hotel, Unley Road, Goodwood
Lunch Club 4th July at Fasta Pasta, South Terrace, Adelaide
Lunch Club 8th August at Caffe Buongiorno, The Parade, Norwood
Lunch Club 12th September at Caffe Brunelli, Rundle Street, Adelaide
Lunch Club 10th October at Goodwood Hotel, Unley Road, Goodwood
Lunch Club 28th November at The Mile End Hotel, Henley Beach Road, Mile End
Rock Climbing 26th April at River Walk, Chapel Hill Road, Blewitt Springs $139.70
Yoga 19th July Venue To Be Announced $65
Women's Self-Defense 15th August at Pimpala Road, Woodcroft $60.50
Tailem Town Ghost Tour 16th October at Tailem Bend Cost To Be Announced
Sailing Twilight Tour 13th December at Port Adelaide Dock $185
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship
Wife
Husband
Partner
Mother
Father
Grandmother
Grandfather
Sister
Brother
Daughter
Son
Friend
Other
Are you happy for DBE to use photos and videos of you on our Facebook, Instragram, website, and any other marketing materials?
Yes
No
If DBE bought a ticket for you then you have to cancel, you will need to find someone to replace you. If you can't find anyone to replace you, you will still need to pay for your ticket.
*
I understand and agree.
Do you need a support worker to come with you to the event? Including picking you up and dropping you home.
*
Yes (we will use your NDIS funding for this)
No
If you picked YES for a support worker to bring you to the event, can you please type names of support workers you want?
What is your NDIS number?
Are you;
Self Managed
Plan Managed
If you are plan managed, please give us your plan manager's email address.
Do you have any questions or want to tell us something?
How will you pay for your ticket? If the event is free, please ignore this.
Bank transfer (BSB: 035 053, ACCOUNT: 502 346, REFERENCE: please use your name)
Online payment (see next question)
Pay now here:
Pay
I understand that The Deaf Butterfly Effect has a 2 business days cancellation policy. I agree that if I do not contact DBE before 2 business days, I will be liable for the full charge. Business days are from Mondays to Fridays, 9am to 5pm and not including public holidays.
*
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