Booking Contact
Name:
Agency:
Contact Number: / Email:
Workshop Facilitators
Name: / Name:
Agency: / Agency:
Phone: / Phone:
Email: / Email:
School and/or Agency Hosting Workshop
Contact Name:
School/Agency
Postal Address:
Phone: / Email:
Dates planned for Workshop
Number of Young People
School year/grade of young people
What is the purpose of the Workshop?
Peer Helping Program / General Life Skills
Other Peer Program / Other (describe in comment section)
Who is the Workshop for? Please provide numbers of individuals for our reporting purposes (e.g. school students, young people general,Aboriginal and Torres Strait Islander Students, Culturally and Linguistically Diverse, young people at risk, young people with disabilities)
Other Comments

THANK YOU FOR YOUR INTEREST IN PEER SKILLS AND YOUR COMMITMENT TO YOUNG PEOPLE.

Workshop Resources Order
Please tick one of the following options:
We would like to order Peer Skills resources (please complete form below)
We are using existing resources for this workshop
Other (please specify)…………….
Standard order: 16 booklets and pre and post workshop evaluation forms charged at $200 plus postage (postage costs will vary and be moreoutside Queensland)
NB. Any additional booklets will be charged at $12.50 per booklet
Resources / Number / Cost
No. of Workshop Participant Booklets Required / $
No. Badges( 16 for $20 / $1.25 each ) / $
Peer Skills USB ( 1 for $15 ) / $
Laminates (please choose from options below)
(a)POOCH A4 (5 in Pack) $20 / $
(b)FEELINGS (104 in Pack) $35 / $
(c)NEEDS (77 in Pack) $25 / $
(d)LISTENING & RESONDING SKILLS (31 in Pack) $20 / $
Facilitator Training Manual (for approved facilitators) $120 / $
Sessional Facilitators if Required (0/1/2) * / $
Postage Cost (check with Peer Skills Admin) / $
Total Cost / $
Resources will be sent when payment has been received. Please allow 4-6 weeks for processing (longer over holiday periods)
*Please contact PeerSkills to check availability of facilitators (if required) and associated costs.
Resource Packs to be sent to / Invoice to be sent to (if different)
Name: / Name:
Role: / Role:
Agency: / Agency:
Address: / Address:
Email: / Fax:
Phone: / Email:
Payment (please ensure payment is included with form)
Is an invoice required prior to payment: Yes No
Cheques made payable to UnitingCare Community ABN 28 728 322 186
Resources will be sent when payment has been received. Allow 4 – 6 weeks for processing
Cash Cheque/Postal Note Direct Credit (Please ask for details)
Credit Card - Visa Mastercard Official purchase order
Name on Card
Card Number Expiry Date /
Contact Details
Francesca Lejeune
Peer Skills Program, UnitingCare Community
483 Ipswich Rd Annerley Q 4103
Tel: 07 3363 2270 / Mob: 0439 870 117
Email: / For registering a workshop, invoicing and payment:
Peer Skills Administration
Email:
Website: