Delegate Registration Form Full name (Preferred) First Name(s): Last Name: Contact Information Mobile: Email: Which state/territory are you from? Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Other Emergency Contact Information Emergency Contact Name Emergency Contact Number Which University/Institution are you from? Do you have any dietary requirements and/or food allergies? Do you have any access requirements or medical needs? Have you attended a previous Queer Collaborations? Yes No Prefer not to say Age Restriction This conference cannot accept registration from people under the age of 16 years. Some night events are at licensed venues requiring delegates to be 18 years or older to attend. Please select your age group below. I am 16 or 17 years old. I am 18 years or older. Registration To find out more about the different types of registration, see our Registration and Pricing Details Weekly Registration ($95) Daily Registration ($28) Payment To complete registration please pay the full amount of your selected ticket into the account below via direct deposit. BSB: 063-408 Acc #: 1075 9490 Account Name: Queer Collaborations Organising Committee Important: Please list your registration name in the message field when paying, so we know that the payment is from you.