Registration – Fanconi Anaemia Support Australasia

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Family Meeting Registration

Event date(s): Friday 30th October – Sunday 1st November

Location: Melbourne, Australia (see programme for details)

Accommodation: Urban Camp (10 Brens Dr, Parkville VIC 3052)

Registrations close 31st May 2020

Name of person completing this form

Given Name

Family Name

Address

Suburb

State

Post Code

Country

Telephone

Mobile

Who are you?

Other

Arrival

Which day do you expect to arrive for the Family Meeting?

Thursday 29th October Friday 30th October Saturday 31st October

Friday's conference / talks

I will be attending the confernce at RCH Melbourne only. (Not going on to Urban Camp)

FASA has booked free accommodation for 50 attendees at Urban Camp (limited places, get in quick!)

Do you wish to stay in the free accommodation at Urban Camp

Yes please No thanks, we'll organise our own accommodation

We are planning a fun outing for Saturday 31st October

Do you wish to attend the outing?

Yes, that sounds great No thanks, we'll relax at Urban Camp

Photography consent

I acknowledge that photos will be taken at the event and may be used for promotional material. If I do not wish for my photo to be used I will indicate below in the Further Details section

Attendee 1:

Name

Age

Gender

Dietary requirements

Attendee 2:

Name

Age

Gender

Dietary requirements

Attendee 3:

Name

Age

Gender

Dietary requirements

Attendee 4:

Name

Age

Gender

Dietary requirements

Further attendees? Please list any additional attendees in the 'further details' field below

Further details

Anything else we need to know?

I would you like to receive information about a research study for individuals with FA and their families which will be available at the meeting?

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