Mind The Step Program - Expression of Interest Form

Thank you for your interest in the Mind the Step program.

Please complete the following few questions and we will be in contact to provide further details of the groups and to discuss whether the program is suitable for you.

Name *

Contact Phone Number *

Contact Email Address

Postcode

Local Council Area (LGA)

1. I am interested in attending Mind the Step program and my preferred times and days of the week are: (Please choose two options)

Group One - starting 25 May: 4 x Tues sessions 9.30am - 11.00am
Group Two - starting 25 May: 4 x Tues sessions 1.00pm - 2.30pm
Group Four - starting 26 May: 4 x Wed sessions 10.00am - 11.30am
Group Five - starting 26 May: 4 x Wed sessions 1.00pm - 2.30pm

2. If none of these dates and times are suitable or we are overbooked, would you like us to keep your details and let you know about future programs that may be held in 2021?

Yes
No

Thank you for your interest in the Mind the Step program.

Please complete the following few questions and we will be in contact to provide further details of the groups and to discuss whether the program is suitable for you.

PLEASE NOTE