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2009 National Young Unionists and Workers Conference
Registration form for the 2009 National Young Unionists and Workers Conference.
Full Name (*)
Please type your full name.
Date of Birth
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 Day/Month/Year
E-mail (*)
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Phone Number (*)
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Address
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 Street Suburb City State/Territory Postcode Country
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Who do we contact in the case of an emergency? (*)
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 Please provide name, relationship, phone number, email and address.
Union/Workplace/Organisation
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What is your role in the union/organisation/workplace?
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Are you coming as a (please tick):


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Can you run a workshop or make a presentation at the conference? If so, please describe it.
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 Please describe your possible workshop or areas of experience.
Do you have any food requirements?
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Do you require any disability support? ie wheelchair access. If so please describe
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Would you like us to assist you with finding accomodation during the conference?
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The registration fee of $50 can be made by an Electronic Funds Transfer (EFT) or paid by Mastercard over the phone. Please indicate below how you will be paying. We will send you an email with the details you will require for your choice.
Payment Method
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If you have any problems with filling out this form please call William or Julia at UnionsACT on 02 6247 7844