‘Te Ara Tāne – The Path of Men’ Registration Form - Yes Disability

‘Te Ara Tāne – The Path of Men.’ Registration Form

Name *

First

Last

Date of Birth: *

Ethnicity: *

Address: *

Phone Number: *

of accessibility Number:

Email: *

Emergency Contact Name: *

First

Last

Emergency Contact Number: *

Do you identify with a disability?: *

Registration Times: *

Is there anything else you would like us to know about your accessibility needs?: