EmailMeForm
Women at the Well Outreach 2022 Registration Form
Date: May 28th
Venue: Eltham Community & Reception Centre
Address: 801 Main Rd, Eltham
Cost: $40 per person
Speaker: Helen Smallwood
Theme: The God I thought I knew
Time: 10am-5pm
Name
First
Last
Ecclesia
Phone
Email
Confirm
Dietary Requirements
First aid certificate or nurse?
Yes
No
Do you require transport to or from the venue?
Yes
No
Friend 1 Name
First
Last
Does Friend 1 require sponsorship?
Yes please
No, I will pay
Friend 1 Dietary Requirements
Friend 2 Name
First
Last
Does Friend 2 require sponsorship?
Yes please
No, I will pay
Friend 2 Dietary Requirements
Friend 3 Name
First
Last
Does Friend 3 require sponsorship?
Yes please
No, I will pay
Friend 3 Dietary Requirements
Friend 4 Name
First
Last
Does Friend 4 require sponsorship?
Yes please
No, I will pay
Friend 4 Dietary Requirements
Are you or any of your friends under 18? If so, please indicate the name of the nominated guardian who will be present.
We are collecting donations for Pinchapoo, to make bags of hygiene items for the vulnerable. If you can contribute please tick the box(es) below to indicate what you would like to bring. (Please note: all items must be new and unopened.)
Shampoo
Conditioner
Individual soaps
Sanitary items
Deodorant
Shaving cream
Hand sanitiser
Dental floss
Lip balm
Hair ties
Body lotion
Razors
Face washer
Hair brush
Hair comb
Anything you would like to add?
Powered by
EMF
Online Order Form
Report Abuse