NDIS Social Activities Expressions of Interest Central Coast Please complete the form below and one of our friendly team members will be in touch. Client Details * First Name Last Name Date of Birth * Country of Birth * Phone (###) ### #### Email * Residential Address * What NDIS Social Activities are you interested in? * Bowling Live Entertainment Group Walking Artists Alike Fishing Book Writing Movie Night Trivia Drag Bingo Golf & Chips Cooking Lets Gym Other If other, please specify activity Are you currently a CCPC NDIS participant? * Yes No Referrer Details (if not the client) First Name Last Name Role Phone (###) ### #### Email How did you hear about our Social Activities? * Word of Mouth Google Search Health Professional Flyer Social Media Event / Expo Family / Friend Other Thank you for registering your interest in our NDIS Social Activities. Our friendly team will be in touch with you as soon as possible.
