2023 Round Table Conference Delegate Registration 2023 Delegate Registration Form Registration detailsPLEASE NOTE: A separate form must be completed for each delegate. This includes partners who may be registering for social events only. If you are bringing your own support worker please contact the Administration Officer to arrange their registration. Name* First Last Email* Enter Email Confirm Email Preferred Phone Number*Including area code, and if outside Australia, country code.Alternative Phone NumberIncluding area code, and if outside Australia, country code.Name for Conference Badge*Please enter your name as you would like it printed on your conference badgeOrganisationPostal Address (line 1)*Postal Address (line 2)Town/City*State/Province*Postcode*Country*Partner Social Events Registration*Do you wish to register a partner to attend Conference Dinner or Welcome Function? No Yes If you would like to register a partner to attend the Conference Dinner or Welcome Function a separate registration must be completed. Please return to the Round Table web site and complete a registration form for your partner after submitting this form. Conference InformationIn order to reduce our environmental footprint, the Round Table Conference is a ‘Paperless Conference’. Conference information will be supplied in accessible electronic formats: - by email to your nominated email address, one week prior to the conference. - for downloading prior to and at the conference (wifi access, within the function area, is included in your conference registration). If for any reason, you are unable to access this information please contact the Administration Officer by email at admin@printdisability.org Accessibility RequirementsPlease Note: Accessibility requirements may not be able to be considered after 5 April 2023. Venue Orientation Guide Dog Facilities Audio Assistance Wheelchair Access Other (please provide details below) Please provide details of any other accessibility requirements.Dietary RequirementsPlease provide details of any special dietary requirements you may have. Vegetarian Vegan Diabetic Gluten Free Other (please provide details below) Please provide details of any other special dietary requirements you may have here.Membership Status*Please enter your membership statusI am a Round Table memberI am not a Round Table memberI am a self-funded consumerConference registration packages (Round Table members)4 day conference registration ($795.00)3 day conference registration ($680.00)selected days and/or social eventsConference registration packages (Non-Round Table members)4 day conference registration ($975.00)3 day conference registration ($890.00)selected days and/or social eventsConference registration packages (Self-funded consumers)4 day conference registration ($470.00)3 day conference registration ($415.00)selected days and/or social eventsSelected days and/or social events (Members)* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Saturday Sunday Monday Tuesday Conference Dinner Welcome Function AGM ABA Workshop (Monday) Selected days and/or social events (Non-Round Table Members)* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Saturday Sunday Monday Tuesday Conference Dinner Welcome Function AGM ABA Workshop (Monday) Selected days and/or social events (Self-funded consumers)* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Saturday Sunday Monday Tuesday Conference Dinner Welcome Function AGM ABA Worshop (Monday) Round Table Members Attendance - 4 day package* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Saturday Sunday Monday ABA Workshop (Monday) Tuesday Conference Dinner Welcome Function AGM Non-Round Table Members Attendance - 4 day package* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Saturday Sunday Monday ABA Workshop (Monday) Tuesday Conference Dinner Welcome Function AGM Self-funded consumers Members Attendance - 4 day package* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Saturday Sunday Monday ABA Workshop (Monday) Tuesday Conference Dinner Welcome Function AGM Round Table Members Attendance - 3 day package* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Sunday Monday ABA Workshop (Monday) Tuesday Conference Dinner Welcome Function AGM Non-Round Table Members Attendance - 3 day package* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Sunday Monday ABA Workshop (Monday) Tuesday Conference Dinner Welcome Function AGM Self-funded consumers Members Attendance - 3 day package* IMPORTANT: Please check ALL the days and events you will be attending from the selection below. Sunday Monday ABA Workshop (Monday) Tuesday Conference Dinner Welcome Function AGM Permission To Share Contact DetailsIn registering for this Conference, relevant registration details (name/organisation/email address and phone number) will be incorporated into a delegate list for the benefit of all delegates, and may also be made available to parties directly related to the Conference. By registering, delegates consent to the collection, use and disclosure of information provided in this registration form in accordance with and for the purpose outlined above. When registering for the conference delegates also give permission for Round Table on Information Access for People with Print Disabilities to use their name and photographs taken at the conference on the Round Table website and in any Round Table publication. IMPORTANT: If you DO NOT AGREE the above please indicate by selecting the appropriate option below: I do not consent to the collection, use and disclosure of information provided in the registration form in accordance with and for the purposes outlined above. I do not give permission for Round Table on Information Access for People with Print Disabilities to use my name and photographs taken at the conference on the Round Table website or in Round Table publications. Conference Accommodation - Please book directly with the venueRydges Sydney Central 28 Albion Street Surry Hills NSW 2010 Australia Bookings can be made directly via Email or Phone: Please quote code Round Table or ID 248534 to access the special conference accommodation rates and advise you are part of the Round Table on Information Access group. Reservations Office (available 9am-5pm Monday-Friday): Phone: Tel: (02) 9289 0000 or from overseas +61 2 9289 0000 Email: reservations_rydgescentral@evt.com Bookings must be made direct with the hotel by Wednesday, 5 April 2023 in order to access the special accommodation rate. All bookings are subject to availability. Please notify the staff at the hotel of any special requirements at the time of booking. Please refer to the Round Table website for more details.www.printdisability.org Total $ 0.00 Payment Methods*Credit Card or PayPalIf you select Credit Card/PayPal you will be re-directed to the payment page on the PayPal website where you can either use your PayPal account to pay or pay by credit card without signing up for a PayPal account. Direct deposit to Round Table’s bank account at the National Australia Bank Swift Code: NATAAU3303M (where applicable for overseas transfer) BSB Number: 083 522 Account Number: 45 742 1243 Account Name: Round Table on Information Access Please clearly identify your deposit with the name of the conference delegate Credit Card or PayPalDirect Credit to Round Table Bank AccountOnce you have submitted your registration please do not close your browser until the registration is complete and an acknowledgement appears. Δ Last updated: December 9, 2022 at 8:54 am
