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.
Feb - Big Duck Boat Tour
Mar - True Crime Tour
May - Adelaide Oval Climb
Jun - Chocolate School
Aug - Goal (Jail) Tour
Oct - Dal Aging Expo
Dec - Sailing Twilight Tour
Which Lunch Clubs would you like to RSVP for?
Feb Lunch Club
Mar Lunch Club
Apl Lunch Club
May Lunch Club
Jun Lunch Club
Jul Lunch Club
Aug Lunch Club
Sep Lunch Club
Oct Lunch Club
Nov Lunch Club
Which Craft would you like to RSVP for?
Feb Craft
Mar Craft
Apr Craft
May Craft
Jun Craft
July Craft
Aug Craft
Sep Craft
Oct Craft
Nov Craft
Dec Craft
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? (Please ignore if you already answered this before)
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 (DBE 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 time do you want the support worker to pick you up?
What is your NDIS number? (If you already gave us your NDIS details, please ignore this)
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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