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Applicant Details
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Attendee Details
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Ticketing
One Person at a Time Conference Registration
Please Note:
Do not use the BACK and FORWARD buttons on your browser, they may end your registration process.
REGISTRATION FORM & TAX INVOICE: BELONGING MATTERS INC. ABN. 93 429 506 771
Name
Email
Postal Address
Phone Number
Mobile
Organisation Name (if applicable)
INTEREST eg. Person with a disability, Family, Worker
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One Person at a Time Conference Registration
MULTIPLE ATTENDEES : How many people would you like to Register for the Conference? (maximum of 5 per registration form)
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5
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Attendee 1 - Name
1. Concurrent Stream 1 - Please Select A, B, or C
A) School Inclusion
B) Finding a paid job
C) Organisational Change
1. Concurrent Stream 2 - Please Select A, B or C
A) Self-Directed Supports
B) Informal Networks & Belonging
C) Creating a Home of My Own
Companion to accompany attendee?
No
Yes
Companion Name
Companion Card Number
Additional Needs (attendee 1)
Dietary
Allergies
Aides/Equipment
Your Assistance
Meals
Wheelchair Access
Bringing Assistance Dog
Bringing Personal Assistant
Other:
Additional Needs Details for Attendee 1
Attendee 2 - Name
2. Concurrent Stream 1 - Please Select A, B, or C
A
B
C
2. Concurrent Stream 2 - Please Select A, B or C
A
B
C
Companion to accompany? (attendee 2)
No
Yes
Companion Name (attendee 2)
Companion Card Number (attendee 2)
Additional Needs (attendee 2)
Dietary
Allergies
Aides/Equipment
Your Assistance
Meals
Wheelchair Access
Bringing Assistance Dog
Bringing Personal Assistant
Other:
Additional Needs Details for Attendee 2
Attendant 3 - Name
3. Concurrent Stream 1 - Please Select A, B, or C
A
B
C
3. Concurrent Stream 2 - Please Select A, B or C
A
B
C
Companion to accompany? (attendee 3)
No
Yes
Companion Name (attendee 3)
Companion Card Number (attendee 3)
Additional Needs (attendant 3)
Dietary
Allergies
Aides/Equipment
Your Assistance
Meals
Wheelchair Access
Bringing Assistance Dog
Bringing Personal Assistant
Other:
Additional Needs Details for Attendant 3
Attendant 4 - Name
4. Concurrent Stream 2 - Please Select A, B or C
A
B
C
4. Concurrent Stream 1 - Please Select A, B, or C
A
B
C
Companion to accompany? (attendee 4)
No
Yes
Companion Name (attendee 4)
Companion Card Number (attendee 4)
Additional Needs (attendant 4)
Dietary
Allergies
Aides/Equipment
Your Assistance
Meals
Wheelchair Access
Bringing Assistance Dog
Bringing Personal Assistant
Other:
Additional Needs Details for Attendant 4
Attendant 5 - Name
5. Concurrent Stream 1 - Please Select A, B, or C
A
B
C
5. Concurrent Stream 2 - Please Select A, B or C
A
B
C
Companion to accompany? (attendee 5)
No
Yes
Companion Card Number (attendee 5)
Companion Name (attendee 5)
Additional Needs (attendant 5)
Dietary
Allergies
Aides/Equipment
Your Assistance
Meals
Wheelchair Access
Bringing Assistance Dog
Bringing Personal Assistant
Other:
Additional Needs Details for Attendant 5
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One Person at a Time Conference Registration
Terms and Conditions
CANCELLATIONS
Cancellations need to be made before 07 .08 .2013 after which a 50% cancellation fee applies.
FINAL REGISTRATIONS
Final registration refers to registrations and payment received by 31st July 2013. If payment is not received by 31st July 2013 attendance will be declined. Registrations will not be accepted without a fully completed registration form listing all attendee names and details.
2 Day Conference
Registration is for day 1 and day 2 of the conference. No single day registration is offered.
Early Bird
Early Bird refers to registrations and payment received by 15th July 2013.
INSURANCE
Delegates are strongly advised to secure appropriate travel and health insurance. Delegate registration fees do not provide such insurance coverage. Belonging Matters do not accept responsibility for losses in this regard.
PHOTOGRAPHY & VIDEOGRAPHY
I acknowledge that there will be photography and videography at the conference and I undertake to contact the conference organisers on info@belongingmatters.org or 03 97398333 if I
do not
consent to still or moving images of me being used for future publicity of the conference.
By Clicking 'Purchase' you are agreeing to the above terms and conditions.
Please select the type of tickets you require, a box will be displayed where you enter the required quantity for each type.
Standard $500
Standard Early Bird $490
Agency Sponsored $285
Agency Sponsored Early Bird $270
Concession $150
Concession Early Bird $150
Student Full Time $285
Student Full Time Early Bird $270
Student Part Time $355
Student Part Time Early Bird $340
Social Gathering $36
Social Gathering Early Bird $26
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