Shed Workshop Registration Form

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THANK YOU FOR SUBMITTING YOUR REGISTRATION TO THE NSW HMMS 'SHED WORKSHOP' FOR 2010

Your Reference # is

Confirmation of this Conference Registration will be emailed to you and an SMS message will be sent to your mobile, if provided

Looking forward to seeing you at the Conference!

Workshop Venue: *

Which workshop will you be attending?

Attendee Details

First Name: *

Last Name: *

Organisation:

Occupation:

Postal Address

Address 1: *

Address 2: *

Suburb: *

State: *

Postcode: *

Phone: *

Contact Number

Mobile:

Fax:

Email: *

Billing Details

Name of Organisation:

Name: *

Postal Address

Address 1: *

Address 2: *

Suburb: *

State: *

Postcode: *

Phone: *

Contact Number

Mobile:

Registration Confirmation will be sent by SMS to this number

Fax:

Email: *

Registration Confirmation will be sent to this address

Privacy Consent: *

Do you give permission for your details to be passed on to Conference Delegates, Sponsors and Suppliers?

Photography Consent: *

Photographs are taken at this event for future information and promotional purposes. During the course of the Conference your image may be taken and subsequently used in publications, on the NSW HMMS Website and other promotions. I give permission for my image to be used for the above purposes

Disability Requirements

Do you have any disability requirements?: *

Yes

Detail:

Dietary Requirements

Do you have any dietary requirements?: *

Yes

Detail: