Vic Winter Conference 2024 event registration

I will be registering as: *

Select your category: *

First Name *

Last Name *

Preferred Email *

As all future communication and emails will be sent to this address, be sure to check that it is correct. The automated confirmation email will only go to this email address.

Mobile Number *

Preferred Name

If you go by a different name instead of your official name, please type it here.

Date of Birth *

Gender *

First Name (Spouse) *

Last Name (Spouse) *

Mobile Number (Spouse) *

Email (Spouse) *

As all future communication and emails will be sent to this address, be sure to check that it is correct.

Child 1 Name *

Child 1 Age *

Please put their age as of the first day of conference.

Child 2 Name

Child 2 Age

Please put their age as the first day of conference

Child 3 Name

Child 3 Age

Please put their age as of the first day of conference

Child 4 Name

Child 4 Age

Please put their age as of the first day of conference

Select your university *

Are you an MSA+ Member *

What is your student ID number? *

What year of study are you in? *

Are you graduating in the next 12-18 months? *

Are you primarily involved in the International Student Ministries? *

If yes, which country are you from? *

ISM students - in payment please select Bank Transfer and do not pay immediately at the end, as you will be contacted by Jun Wen Lim to inform if there are further discounts available to you.

Which Power to Change worker/volunteer are you discipled by or knows you best? *

Who in Power to Change invited you or knows you best? *

Are you new to Power to Change this year? *

Please select the option(s) that describes you. *

I am not a Christian but I'm exploring who Jesus is

I am a relatively new Christian (Christian for one to two years)

I have been a Christian for longer than two years

I have been to Power to Change events on campus

I am actively serving in my local church

I have participated in an evangelism hour (eg. Salt Hour, Walk-up, E-team) on campus with Power to Change

I have been a leader of an evangelism hour (eg. Salt Hour, Walk-up, E-team) on campus with Power to Change

I have been on a Summer Project with Power to Change

None of the above

If applicable, which church do you attend?

Do you have any dietary requirements or food allergies?

For food allergies, please include the severity.

Does your spouse have any dietary requirements or food allergies?

For food allergies, please include the severity.

Do you have any medical conditions?

Please give details of any medical conditions that are or may be relevant to your attendance. If your condition requires medication, please specify if you are bringing your own.

Do any of your children have any dietary requirements or food allergies?

Please include the name of your child alongside the dietary requirement or food allergy. For food allergies, please also include the severity.

Does your spouse have any medical conditions?

Please give details of any medical conditions that are or may be relevant to your spouse's attendance. If your spouse's condition requires medication, please specify if they are bringing their own.

Do your children have any medical conditions?

Please give details of any medical conditions that are or may be relevant to your child's attendance. Please indicate clearly the name of the child along with their medical condition. If their condition requires medication, please specify if you are bringing it for them.

Do you have a First Aid Qualification that will be valid until Saturday 6th July 2023? *

What kind of First Aid Qualification do you have? *

Please specify the type of First Aid Qualification you have, including CPR.

Emergency Contact Name *

Please put down your emergency contact. This should be someone who is not at the conference (but is in Victoria).

What is their relation to you? *

Emergency Contact Number *

Please ensure that this number is correct.

Provider

If you are an international student, please provide your overseas health cover details which may be used in the case of an emergency.

Policy Number

Your name as it is on the policy

If different from your name entered at the beginning

Contact Number (Including country code) *

Please put the contact details of a family member. If they are not in Australia, please include the country code.

Room Allocation

Please put the name(s) of people you would like to room with. We will do our best to put you with at least one of these people or someone you know.

If possible, would you like to room with early sleepers? *

Please arrive at Robert Blackwood Hall at Monash Clayton Campus by 11:30am for a 12:00pm departure on Tuesday July 2nd. The shuttle bus will arrive at the campsite at approximately 2:00pm. The shuttle bus will depart from Phillip Island Camps at 12:00pm and will arrive back at Robert Blackwood Hall at Monash Clayton Campus at approximately 2:00pm. Please let us know if you are not planning on taking the shuttle bus.

Payment Method *

Qualify for a reduced rate? Be sure to use the code EarlyBird, Explorer or FirstYear in the coupon section below. FOR MONASH CLAYTON STUDENTS: Please only pay via Bank Transfer

Support Account Number *

Cancellation and Refund Policy *

I acknowledge that I must pay by the deadline (9th June) for my registration to be processed. If payment or the remittance advice of payment has not been received by the deadline, your registration will be considered incomplete (cancelled).

I acknowledge there are no refunds for voluntary cancellations after the deadline (9th June).

Please tick both boxes above to acknowledge you have read and understood the cancellation policy.

Please select any jobs/roles you would be interested in potentially helping out with

This is to gather expressions of interest but we will get in touch with you to discuss further.

Photographs and videos taken at Winter Conference may be used by Power to Change online or in future promotional material. If you would like to speak to someone about this or do not wish for your photos to be used in this way, please email vicmyc@powertochange.org.au after you submit your registration.

Privacy Statement *

©Power to Change ABN 25126098398 is an international faith based mission that connects people to Jesus and each other. We respect your privacy and will only use your information to do what you have asked (e.g. conference registration) and to keep you informed of our work. We will not pass your details onto unrelated third parties and we will allow you to opt out of our publications. See our Privacy Policy at www.powertochange.org.au

Please tick the box above to accept these terms and conditions.

FOR MONASH CLAYTON STUDENTS: Please only pay via Bank Transfer

Amount

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Gross amount

Coupon

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Select a payment option above

Credit Card Number*

Expiration Date*

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Card (CVV) Code*

Card Type*

Card Holder Name*

*

Verification code*

Registration

Personal Information

Overseas Student Health Cover Details

Conference Specific

Transport Information

Payment and Policies

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