ACD Educate – ACD Connect Registration ACD Connect Registration form Date Date Format: DD slash MM slash YYYY Please select the ACD Connect group you would like to attend:*Bayside Region ( ACD MEMBERS ONLY)BendigoWarragul ( FULLY BOOKED)CardiniaCaseyDarebinManninghamMaroondahMonashMorelandSunburyWhittleseaWyndhamGeelongHorshamSaleSheppartonTrarralgonCobramSeymourMansfieldPlease note that ACD Connect workshops are for ACD members only. To become a member please complete the online membership application form.Personal DetailsIndividual registration informationName* First Last Address* Street Address Address Line 2 Suburb State Post code PhoneMobileEmail* Enter Email Confirm Email Are you a current ACD member?*YesNoUnsureAre you Aboriginal or Torres Strait Islander?*YesNoDo you require an interpreter?*YesNoWhat is your preferred language?Your Child's detailsPlease provide some information about your child with a disability.Child's Name* First Last Child's age*Please enter a number from 0 to 25.Disability*Do you have any accessibility requirements?*YesNoIf yes, please specify the accessibility requirementsHow did you hear about ACD Connect?*InternetEmailFlyerSupport GroupFamily/friendACDOtherIf other, please tell usSecurity CheckPhoneThis field is for validation purposes and should be left unchanged.