WA Winter Conference 2024 event registration

I am registering as: *

Which category best represents you? *

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.

Phone number *

Please write in the format xxxx xxx xxx

Gender *

Date of Birth *

What size hoodie/jumper would you like to order? *

Which category do you fall into? (Spouse) *

First Name (Spouse): *

Last Name (Spouse): *

Preferred Email (Spouse) *

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

Phone (Spouse) *

What size jumper would you like to order? (Spouse) *

Is this your first Power to Change Conference? *

Which campus are you from? *

If you selected other, please tell us where you are from *

Is this your first year of university? *

Is this your final year of university? *

If you have been involved with us before, please indicate which Power To Change worker or leader you know best. *

The Power To Change leader I know best is: *

Are you an international student? *

'Is there any person(s) you would prefer to share accommodation with?

We will do our best to room you with your preferences but there is no guarantee.

Please list out any dietary requirements/ food allergies that you have that we need to be aware of

If this is for a couple or family registration be sure to include the person's name

Please list any medical conditions that you have that we need to be aware of

If this is a couple or family registration be sure to include the person's name

Do you have a valid First Aid certificate?

If this is a couple or family registration be sure to include the person's name

I have completed the following training modules: *

How do you plan to Travel To / From Winter Conference? *

I am driving and can take: *

Are you driving to/from conference and are under the age of 21 or have had your drivers licence for less than two years? *

Street Address *

Suburb *

Emergency Contact Name & their relationship to you *

Emergency Contact Phone Number *

Would you like to share anything else that might be helpful for the conference organisers to know?

Would you like to apply for a Discount / Subsidy? *

Your final Winter Conference payment will be adjusted accordingly, please contact John on 0402 656 915 for more details. If you selected 'A Combo of the above' a Winter Conference Design Team Member will be in touch soon, to clarify your final Winter Conference cost.

Please list the name of the friend who invited you

Payment Method *

For Credit Card payments, please contact John Mayne. Fees may apply.

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 (eg, registration, donation, subscription) 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 powertochange.org.au

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

Amount

Payment Method

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Credit Card Number*

Expiration Date*

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Card (CVV) Code*

Card Type*

Card Holder Name*

*

Verification code*

Registration

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