Name

Registration
Type

Year 12 ($180)

Student ($225/240)

Worker ($245/260)

Address

Suburb

State

Post Code

Contacts

Home Phone

Mobile Phone

Email

Dietary
Requirements

Emergency
Contact

Name

Phone

Medical
Information

Help! I need a lift there!

I'm okay for transport.

I consent to my contact details being
made available to conference attendees.

I am one half of a married couple.

I have transferred the deposit full amount of $

I can only attend part-time on:
Mon Tues Wed Thurs Fri Sat