Encounter Youth Education Booking Enquiry

What would you like to do today?

I want to bookI want to find out more information or ask a question

Where are you located?

School & Contact Details

School/Organisation Details

School Name

Street Address

Suburb

State

Postcode

Contact Person Details

First Name

Surname

Phone

Mobile Phone

Position Within School

Privacy

I agree that my personal data may be used in accordance with your Privacy Policy.

What is your enquiry?

Booking Details

Which program would you like to book?

Middle school program (Years 7-9 + parents or staff)Middle school program with vaping content (Years 7-9 + parents or staff)Senior school program (Years 10-12 + parents or staff)Senior school program with vaping content (Years 10-12 + parents or staff)Full secondary program (Years 7-12 + parents or staff)Full secondary program with vaping content (Years 7-12 + parents or staff)Stand-alone Safety at Schoolies SeminarStand-alone Vaping SeminarOther

Please describe the program you would like to book

First preference date

Second preference date

When is the best time to contact you?

This form is an expression of interest. While we will endeavour to hold your preferred dates to the best of our ability, there is no guarantee that your preferred dates will be available.

Confirmation of this booking will still be required after discussion with an Encounter Youth staff member.

How did you hear about Empower Education?

I have booked previouslySearch engine (Google, Bing, Yahoo etc.)Word-of-mouth referralConference or expoEncounter Youth flyerEncounter Youth emailEncounter Youth letterOther

Contact Information

Information submitted through this form is collected and used in accordance with Encounter Youth's Privacy Policy