Walk for Community Welfare Program Registration Form
Date : 14 August 2022
Time : 7am – 9am
Venue : J.C. Slaughter Falls, 38 Sir Samuel Griffith Dr, Mount Coot-Tha QLD 4066

Please submit a separate form for each participant of your family.
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Name: *
Address: *
Contact No: *
Emergency Contact in case of Emergency:
Emergency Contact's Phone number:
Registration Type and Fees *
If you selected Family in previous question, please enter the name of the each family member with clearly indicating adult, or children or visiting family member. For example, FirstName LastName (Children), FirstName LastName (Adult), FirstName LastName (visiting father).
T-Shirt Size *
Do you need pick up/drop off service? *
Payment reference: After this registration, please use the account details below to pay registration fees and send the screenshot of your payment receipt to: treasurer.qld@nrn.org.au. Account Name: Westpac Community Solutions One | BSB: 032 006 | Account Number: 561817 | Reference: WFCW [Your Name]. Did you make the payment? *
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