bethlehem huntingtons workshop registration

First name *

Last name *

Title *

Discipline *

Role *

Organisation *

Phone number *

Email address *

Address *

Street address *

City *

State *

Postcode *

Dietary requirements *

YesNo

Please specify: *

Do you consent to photography during the workshop for use in future education, social media and Calvary communications internal and external? *

YesNoConditional

Please provide details on your filming preferences:

Do you currently work with people with Huntington’s Disease? *

YesNo

How do you consider your skills with prescribing wheelchairs and seating for people with Huntington’s Disease? *

BeginnerIntermediateAdvanced

What are you most hoping to learn in this workshop?

Do you have any special needs or anything you would like us to know about you? *

YesNo

Please specify: