Annual Conference - Delegate Registration Form

Delegate Submission

• Delegates must be voting financial members of the Association.
• Only one (1) Delegate or Alternate Delegate per membership is allowed.

Refer to Annual Conference Representation Schedule to obtain the number of delegates your District Council is entitled to send to the Annual Conference.
Complete the details in full making sure you include Membership Numbers.
Separate forms are included for advice of Delegates and Alternate Delegates
Forms must be submitted by Friday 7 May 2010.
Please advise Head Office of any changes in the delegates representing your District Council.

You will need to fill in one form per delegate, there will be an option to submit another delegate on the confirmation page after you click on the Submit Button.

Submitted by:
Email Address:
District Council:
Region:

DELEGATE INFORMATION

Delegate Type:
Member No:
Title:
Surname:
First Name:
Preferred Name on Name Tag:
Gender:
Age:
Address:
Phone:
Mobile:
Email:
Days Attending:	Tuesday Wednesday Thursday

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Delegate Submission

Submitted by:

Email Address:

District Council:

Region:

DELEGATE INFORMATION