2024 Registration Form
Last day to register - 21 May 2024
Your Name
*
First Name
Last Name
Organisation
*
Phone Number (mobile preferred)
*
E-mail
*
example@example.com
I reside in:
*
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Canada
England
New Zealand
United State of America
Other
Select one.
Registration type:
*
Please Select
Attendee
Speaker
Staff
Select one.
I will be attending the event as a:
*
Carer
Consumer
Clinician
Researcher/Educator
Service Provider
Policy Maker
Other
Select all that apply.
I am registering to attend the forum on:
27 May 2024 - In person 11.30am to 5.30pm
*
Yes
No
27 May 2024 - Networking Function 5.30pm to 7.30pm
*
Yes
No
28 May 2024 - In person 8.00am to 3.30pm
*
Yes
No
In supporting Forum attendees to maximise your opportunity to network and connect, and to receive program updates, we will be setting up a Forum What's App group. Please indicate if you would like to join?
*
Yes
No
Would you like to be updated about the upcoming Equally Well events and news?
*
Yes
No
Submit
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