Conference Registration

Partnerships, Prevention & Rural Action IV

A conference on Empowering and Supporting Aboriginal Women & Young Girls

To register online, use this form. You can also register by printing out the Registration Form

Online Registration Form

Organisation Representative (required)
Note that for any person attending on behalf of an organisation there will be a cost of $350.00

Community Member (required)
YesNo
Your Address









expiry month:

Children age 7 and under are able to attend:

Name DOB
Name of child 1
Name of child 2
Name of child 3
I will be attending the Conference on:

Please select days. If attending all days, select all.

Do you require transport to attend the conference?

Transport assistance is available if required. If you need assistance then staff will contact you by telephone (please make sure you provide a phone number) to speak with you about your travel.

I will require a special diet:

I will need:

Medical staff will be available at the conference
I need to have medical checks on a daily basis for:

Participants can attend on a daily basis. If you wish to attend daily and not stay at the Lake Burrendong accommodation provided, which days will you be attending?

On these days I will require:

Please contact Gail on 1800 639 784 (free call number) or 02 87456900 if you have any queries.

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