Wise on Wheels Workshop with Joblink Plus Dubbo

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 *

Mobile Number *

Email Address *

Catering will be provided during the event - please advise dietary requirements

How did you hear about this event? * Select ... Email SMS Joblink Plus - in person Word of mouth - friend

Photo Consent: I give permission for organisers to take photos of myself. Any photos of me taken at this event can be used by Joblink Plus, Drive4Life and Women on Wheels for promotional materials and on social media. * Yes
No

How confident do you feel about keeping yourself safe in the car? * Not confident
A little confident
OK
Confident
Very confident

How confident are you to check your car is safe to drive? (for example: tyres, warning lights, wipers) * Not confident
A little confident
OK
Confident
Very confident

How well do you understand road rules and laws about car maintenance in Australia? * Not at all
A little
OK
Well
Very well

What is your age? * 18-20
21-30
31-40
41-50
50-plus

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

What is your driving status? * Full licence holder
P-plate driver
Learner driver
No licence

Are you or have you ever been part of the Drive4Life program? * Yes
No

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