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Deerubbin Conference Application



Deerubbin Conference

Friday 11 - Sunday 13 March 2016
Milson Island, Hawkesbury River, via Brooklyn, NSW.

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Step 1 - Personal Information

Full Name*

Address*

Postcode/Zip*

Email*

Mobile*

Telephone


Step 2 - Educational Information

Degree(s) / Diploma(s):

Year and Institution:

Degree(s) / Diploma(s):

Year and Institution:

Other Qualification(s):

Year and Institution:

Professional Membership:

Year and Institute:


Step 3 - Employer Information

Employer(s):

Other:


Step 4 - Other Information

In what country were you born?

In what country is your permanent residence?

Please specify your gender:

 Male Female

Do you have any disabilities or impairment(s)?

Please provide briefly any other information or comments


Step 5 - Declaration

I confirm that I have read the information on the official web site and in the publicity and that I understand that registration for the conference is subject to payment of the conference fee prior to the date stipulated on an official invoice that will be issued through PayPal.

Name in Full

I understand that the conference fee includes accommodation (bunk house share), all food, and ferry transfers as scheduled.

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