I AM Conference Registration Form

Confidentiality Notice
Your information will be kept confidential and deleted after the conference. We will not use the information provided here for marketing purposes.

Medical Information
We are requesting medical information solely for use in the event of an emergency, to assist emergency responders in providing appropriate care.

Medical Conditions, Surgeries or Hospitalisations:
If you have nothing to declare or choose not to declare, please respond with “None”.

Dietary Restrictions, Accessibility Needs or Allergies
Please declare any dietary restrictions, accessibility requirements, or allergies below so we can make appropriate arrangements in advance.
Note: We may be unable to cater to your needs if your information is not submitted at least two weeks prior to the event.

If you have nothing to declare, please respond with “None”.

Please read the event Terms & Conditions

Name

Preferred Name

Date of Birth (DD/MM/YYYY)

Phone Number

Alternative Phone Number

Email Address

Address

Occupation

Medical Conditions

Allergies

Dietary Restrictions

Accessibility Needs

Surgeries or Hospitalizations

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Terms & Conditions