Step 1 of 4 25% Step 1 of 4: start the registration process here Thank you for taking the time to register for a workshop. Please fill in the following information to the best of your ability. Fields marked with an asterisk (*) are required fields. If you require any assistance at any time, please do not hesitate to call us on 1800 688 831.Which workshop(s) would you like to attend? (Select all that apply) * Required NDIS Self-Management Post-Traumatic Growth Speaking up for Yourself Info Session - NDIS: What Can I Purchase? Please select the NDIS Self-Management workshop date you'd like to attend: * Required The workshop I am interested in has no current dates. Please register my interest for the next workshop. Please select the Post-Traumatic Growth workshop date you'd like to attend: * Required Monday 4 December, 10am - 11.30am (Online using Zoom) The workshop I am interested in has no current dates. Please register my interest for the next workshop. Please select the Speaking Up For Yourself workshop date you'd like to attend: * Required Monday 11 December, 6pm - 8.15pm (Online using Zoom) The workshop I am interested in has no current dates. Please register my interest for the next workshop. Please select the "Info Session - NDIS: What Can I Purchase?" date you'd like to attend: * Required Thursday 14 December, 10.30am - 11.30am (Online using Zoom) The info session I am interested in has no current dates. Please register my interest for the next info session. Please select the option that applies to you: * Required I am a person with disability I support a person with disability (unpaid role) I am a service provider, other organisation, student or community member without disability These workshops are only for people with disability, parents of adults or young people with disability and partners or family members providing direct informal (unpaid) support. For more details call PDCN on 1800 688 831. Will the person you are supporting be attending this workshop? * Required Yes No Is the person you support under the age of 7? * Required Yes No Has the person you support attended any PDCN workshops before? * Required Yes No Have you attended any PDCN workshops before? * Required Yes No Your Name * Required First Last Best Contact Number * RequiredYour Email Address * Required Do you currently have an NDIS Plan? * Required Yes No Have applied / Wanting to apply Status of Application * Required Does the person you support currently have an NDIS Plan? * Required Yes No Have applied / Wanting to apply Status of Application * Required Your Details Step 2 of 4: address, date of birth, and disability details Please fill in your personal details to register for this workshop. Fields marked with an asterisk (*) are required fields. If you require any assistance at any time, please do not hesitate to call us on 1800 688 831.Your Address * Required Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Preferred Contact Method * Required Phone Email SMS/Text How would you describe your, or the person you are supporting’s, disability? (Select all that apply) * Required Physical disability Blind or low vision Deaf or hard of hearing Intellectual disability Neurological disability Psychosocial disability or mental health condition Other (please specify) Please describe other disability: * Required Do you identify as Aboriginal or Torres Strait Islander? * Required Yes No Do you identify as culturally and/or linguistically diverse? * Required Yes No Details of the Person you Support Step 3 of 4: enter details of person with disability you support Please fill in the personal details of the person with disability attending this workshop. Fields marked with an asterisk (*) are required fields. If you require any assistance at any time, please do not hesitate to call us on 1800 688 831.Their Name * Required First Last Their Address * Required Same as above Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Their Best Contact Number (optional)Please enter a contact number if the person you support would like to be contacted directly. Otherwise, leave blank.Their Email Address (optional) Please enter an email address if the person you support would like to be contacted directly. Otherwise, leave blank.Their Date of Birth * RequiredDD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Only if they wish to answer this question, please choose all that apply: Aboriginal or Torres Strait Islander Culturally and Linguistically Diverse (from a non-English speaking background) LGBTQIA+ I prefer not to answer I do not identify with one of these groups Workshop Information Step 4 of 4: workshop details and extra support requirements Please choose the workshops you are interested in as well as any access or communication needs we may need to know about. Fields marked with an asterisk (*) are required fields. If you require any assistance at any time, please do not hesitate to call us on 1800 688 831.Do you have any physical access or communication needs we should know about? * Required None Wheelchair or Level Access Hearing Loop Auslan Interpreter Language interpreter Other (please specify) Please describe other access or communication needs: * Required Will a family member, support person or support worker be attending this workshop with you? * Required Yes No Please tell us you family member, support person or support worker's name: * Required How do you currently manage your plan? * Required NDIA managed Plan managed Self-managed Combination I am unsure HiddenDo you have any dietary requirements? (HIDDEN UNTIL IN-PERSON WORKSHOPS RUNNING AGAIN) How did you hear about this workshop? * Required Friend Service provider PDCN website Facebook Twitter Google/internet search Promotional flyer PDCN marketing email School University/Tafe Other Please specify how you heard about this workshop: * Required Please tell us briefly what you are hoping to get out of the workshop (or workshops if you have selected more than one). * RequiredService User Rights and Responsibilities / Privacy Policy * Required I have read and understood the Service User Rights and Responsibilities and the Privacy Policy. Subscribe to PDCN Events and Marketing Please check this box if you are interested in finding out more about PDCN events and receiving our email newsletter. Become a PDCN Member If you are a person with physical disability, or a representative/carer of a child under 16 with physical disability, we welcome you to become a PDCN member for free. Others are welcome to become Associate Members for $37 per year. Your Date of Birth * RequiredDD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please specify your physical disability * Required Acquired Brain Injury Amputee Arthritis Autism Blind Cerebral Palsy Deaf Down Syndrome Hearing Impaired Intellectual Disability Motor Neuron Disease Multiple Sclerosis Osteogenesis Imperfecta Paraplegia Parkinsons Disease Polio/Post-Polio Quadriplegia Spinal Cord Injury Vision Impaired Other Other Disability Type * RequiredWork Status * RequiredFull-time employedPart-time employedCasually employedUnemployedSelf-employedRetiredStudentVolunteer Δ
