Family Advocacy

*** Final registrations close 12 March 2010***

Name:
Organisation: (if applicable)
Role in Organisation:
Postal Address:
Town/ Suburb:
State:	Postcode:
Email:
Telephone (Work):	Home:
Fax:	Mobile:

Please enter the code from above

Please specify names of all participants covered in this registration:

Particular Dietary Requirements (specify per participant):

Other support requirements (please specify, i.e. accessible premises, etc.):

Please select the categories that you and the other participants come under.

	No. of participants
Person with Disability/ family member/ friend/ ally		x $10
Student		x $10
Professional/ Person working in the Disability Field		x $30

Total: ($)

I wish to pay by cheque

Any cheques that you send to us must be marked on the back of the cheque with this reference number INC0070 and your name. Please send your cheque made payable to "Family Advocacy" to PO Box 502 Epping NSW 1710.

I wish to pay by Credit Card

Details on paying via Credit Card will be appear on the next page once you have clicked on "Register for Conference". To pay by bank transfer, you will need to set up a paypal account. See next page.

For payments over $100 or for other payment options, please contact us on 02 9869 0866 or 1800 620 588 (outside Metro Sydney only) to make payment.