Women on Wheels Workshop at Mildura Toyota

Number of Registrations 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

First Name *

Last Name *

Email *

Phone *

Suburb *

Post Code *

How did you hear about this event? * Flyer
Employee
Newspaper
Email Invitation
Radio
Friend/Family
Social Media
Website
Noticeboards
Other

Age Bracket * 15-17
18-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90

Dietary Requirements

Are you an existing customer of this workshop/dealership? * Yes - purchased
Yes - servicing
I have visited but not purchased from or serviced
No, I have never visited

What is the make/model/year of your car? *

Driving Status * Learner Driver
P-Plate Driver
Helping Learner Driver
Full Licence

If you know someone else who has registered, state their name/s to be grouped together. Note: Individuals must register separately.

Comments

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