2025 Registration Form
Your Name
*
First Name
Last Name
Organisation
*
Please write N/A if none.
Postal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Phone Number (mobile preferred)
*
E-mail
*
example@example.com
Registration type:
*
Please Select
Attendee
Speaker
Select one.
I will be attending the event as a:
*
Consumer
Carer
Clinician
Researcher/Educator
Service Provider
Policy Maker
Other
Please list other.
*
I am registering to attend the conference on:
Thursday, 20 November 2025 - 9.00am to 5.30pm
*
In person
Virtual
Not attending
Thursday, 20 November 2025 - Networking Function 5.45pm to 7.45pm
*
Yes
No
Friday, 21 November 2025 - 8.30am to 4.00pm
*
In person
Virtual
Not attending
For catering purposes please indicate any dietary requirements.
*
Please Select
No requirements
Dairy-Free
Vegan
Vegetarian
Gluten-Free
Other
Please list other requirements
In supporting conference attendees to maximise your opportunity to network and connect, and to receive program updates, we will be setting up a conference 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
I understand, for catering purposes and to allow others the opportunity to attend the event should I be unable, the following fees may apply:
*
if I cancel my registration after 15 November 2025 there will be a $200.00 cancellation fee or, if I do not attend the conference there will be a $400.00 cancellation fee.
Submit
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