Please note you are registering for the Movie Day Out in Tweed Heads. If you wish to register for another National Carers Week event please visit www.carersnsw.org.au/training-events/upcoming-events.

 
First Name*
 
 
Last Name*
 
 
 
 
 
 
Phone Number*
 
 
Email address*
 
 
 
Age*
 
 
Postcode*
 
 
 
 
 
 
Do you wish to bring care recipient?*
 
 
 
If yes, please indicate the number of care recipients you wish to bring.
 
 
 
 
 
 
Are you registered with Carer Gateway? *
 
Yes
No
 
 
If you answered no and are a carer living in the Central Coast, Hunter New England or North Coast regions of NSW and would like to register with Carer Gateway, please call 1800 422 737 Monday – Friday 8.00am to 5.00pm and select option one to speak with your local service provider. Alternatively, you can visit www.carergateway.gov.au/request-call-back to request a call back and begin the registration process with your local Carer Gateway provider. 
 
 
 
How did you hear about this event?
 
 
 
 
 
 
The following questions are optional; 
 
 
 
Are you from a Culturally and Linguistically Diverse background?
 
Yes
No
 
Are you from an Aboriginal and / or Torres Strait Islander background?
 
Yes
No
 
Do you identify as LGBTI?
 
Yes
No
 
Do you have a disability?
 
Yes
No