Workshop Registration Form

Fields marked with a * are required.

Contact Details
Full Name *	Email Address *
Work Phone Number *	Mobile Number *
Work Address *	City *
State *	Postcode *
Country *

Course Details
Company *	Supervisors Name
Course Attending	Date of Course
Name to be Printed on Certificate
Amount Payable
Payment Option * Direct Deposit Cheque/Money Order Invoiced	Account Name: Volunteering ACT BSB: 112-908 (St George Bank) Acc Number: 40037781 Invoice to Please make the Cheque payable to: Volunteering ACT Inc.
Enter Word Verification in box below *

“I am feeling for the first time in a while that there’s hope for me” - Connections participant»