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Title

First name

First name (not preferred name)

Last name

Family name (surname)

Email address

Password

Confirm password

Birth date

Gender

Mobile number

Phone number: (home/work)

Address

Are you Aboriginal and/or Torres Strait Islander?

Which country were you born in?

What is the main language you speak at home?

How well do you speak English?

Which answer best describes your current employment status?

What is your primary occupation or volunteer role?

If 'Other' please enter.

If you have selected 'other' for your Occupation.

Organisation: What is the name of the organisation you work for?

Must be spelt out.

Organisation location: What is the location of where you work?

Suburb then State (example: Sydney, NSW)

Do you have any dietary requirements?

Do you have any participatory requirements?

How did you hear about us?

I declare that the information I have provided is true and correct to the best of my knowledge.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice.

05 February 2025

7:00pm - 9.00pm

Central Deborah Motel Conference Room, 177-183 High Street, Bendigo, VIC 3550
View in Google maps

Training is delivered on behalf of Lifeline Australia RTO 88036

If you are eligible to attend a workshop, when your enrolment is approved you will receive a confirmation email within 10 working days.