Life Matters application QLD 31 May - 2 June
Thank you for applying to join the Life Matters workshop - Friday 31 May to Sunday 2 June (2-day workshop) plus two follow-up sessions. 
Email *
Full Name
 *
Email address
 *
Phone number
 *
Gender
 *
Age
 *
Address
 *
How did you find out about Life Matters
 *
Tell us a little about yourself and why you want to do the LM workshop? Please write at least 50 words. *
What are your hopes for your future? Please write approx. 50 words *
Dietary requirements - do you have any dietary requirements? If so please advise. *

Initiatives of Change Australia (IofCA) sometimes posts photos or videos on our website, social media or publications to share about our activities. 

If in attendance do you consent to IofCA using photos and/or videos of you for this purpose?
Clear selection
Disclaimer: Life Matters invites participants to reflect on their own lives, and for some people this may involve connecting with painful past experiences. Each Life Matters workshop has trained counsellors who can offer support as needed, but please note that Life Matters is not therapy and is not a substitute for therapy. At all times you are responsible for your own health and mental health and must decide whether Life Matters is appropriate for you.

I have read the above and accept personal responsibility for my participation in Life Matters.
 *
Please let us know if you have any health or mental health conditions that may impact your ability to participate in Life Matters. (This information is confidential and will not shared with anyone beyond the course organisers). We may contact you to discuss how to provide the appropriate level of care to enable your participation.

The total fee for the workshop is:

 $500 covers program, accommodation and meals,            

**  Limited scholarships are available on application here: https://forms.office.com/r/DuTPQCcnq9)

Registration fees

Registration fee will be $50, inclusive of the overall price of $500.

Please deposit the registration fee to the following account:

Initiatives of Change Australia

BSB: 083-427

A/C No:  51 509 4958

Please add "LM QLD Rego Fees" and your first and last name in the description.

Fee payment - Please specify your requirement (we will send you an invoice for payment prior to the workshop) 

 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms