10-day Program Registration Form

Select Program *
Use this form to request a sponsored place on a program. Note that sponsorship applications must be submitted at least 30 days prior to the program. Your place on the program is not confirmed until payment has been made. If you would like to pay by credit card please go back to previous page. Once you submit your form please download the information pack. The CareMonkey system will generate medical and permission forms for you to complete online. We do not offer refunds less than 6 weeks prior to the program, however you are welcome to switch to a later program so please consider carefully prior to making a booking. If you have any questions regarding the bookings form or procedure you can email the Bookings & Communications Manager at info@mittagundi.org.au. They will usually get back to you within 2 business days.
Participant Name *
Participant Name
Booking Person's Name *
Booking Person's Name
Home Address
Home Address
Date of Birth *
Date of Birth
Please pick me up from *
Booking Request *
Your placement on a program is not confirmed until FULL payment has been received.