Latrobe Health Innovation Zone - Workshops Registration Form Thank you for your interest in the Latrobe Health Innovation Zone Workshops! This is a simple registration form - the details you provide here will be used for catering and resourcing the workshops. OK Question Title * 1. What is your name? OK Question Title * 2. Please provide your phone number and / or email address to receive workshop correspondence: Phone number Email address OK Question Title * 3. Please select the workshops that you would like to attend. You are welcome to attend each of these workshops. However, you may wish to come to the one that is closer to where you live. Everyone is encouraged to attend the final workshop on 24 October. Tuesday 12 September 5.30 - 8.30pm (Churchill Community Hall) Tuesday 26 September 5.30 - 8.30pm (High Street Community Hub, Moe) Tuesday 10 October 5.30 - 8.30pm (The VRI Hall, Traralgon) Tuesday 24 October 5.30 - 8.30pm (Lifeline, Morwell) OK Question Title * 4. Please provide details of any dietary, transport or access requirements that we should take into consideration to help make your attendance at the workshops easier. Dietary restrictions - please describe I have access requirements - please describe I will have children with me - please indicate how many I need transport to / from the workshop - please provide contact details so we can arrange transport options with you OK Question Title * 5. Would you like to participate as a member of the Advisory Committee? Yes please No thanks Don't know / undecided OK Question Title * 6. Is there anything else you would like to share with us? OK DONE