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6th National Forum

Registration Form - Delegates and Representatives

You may complete your Forum Registration online or print a copy of the form (below) and post or fax it to the NCCA. If you complete your registration online you will receive a copy of your Forum Registration as Confirmation. This form is only for Delegates and Observer Church Representatives.

The Registration Form .pdf (click here) requires Adobe Reader to open. If you do not have a current version of Adobe Reader click on the button (right) to download a free copy.

Registering for the Forum does not require immediate payment. Registration and meals at the Alexandra Park Conference Centre (APCC) is $400.00 per person (Friday evening through Tuesday lunch). For information regarding accommodation options and costs, please, click here.

You can pay online via credit card or direct debit, or a cheque may be sent to NCCA, 6th National Forum, Locked Bag 199, Sydney NSW 1230. Cheques to be made payable to 'National Council of Churches in Australia'. A link to pay online will appear once you submit your form.

Please, send questions or detail changes to the Forum Organiser, Steven Pearse.

* Mandatory Fields

Personal Details

*Surname:

*First Name:

Title:

Preferred Name for Identification Badge:

*Postal Address:

*Suburb or Town:

*State:

*Post Code:

Telephone No. (Home)
Please include your STD code.

Telephone No. (Work)
Please include your STD code.

Mobile Phone No.

Email Address:
Please provide your most accessed address.

*Church/Organisation:

II.

Forum Participation
I will be participating in the Forum in the role of: (Please select only one designation)

*Forum Role:

	Delegate of an NCCA Member Church
	Delegate of a State Ecumenical Council
	Observer Church Representative

III.

Specific Physical Conditions
Please answer the following questions to aid the Forum Organisers to meet any special needs you may require or be in need of in an emergency.

Do you suffer from any allergies?
If yes, please explain details and management in such an event.

Specific Dietary Requirements:
Please outline your personal requirements in detail.

Special Access Needs:
Please identify any specific areas of concern pertaining to your abilities to access areas. For example, you may use a wheelchair and therefore require wider doors, handrails etc.

Contact Name:
In the case of a Medical Emergency.

Relationship to you:
For example, Husband, Wife, Daughter, Son, Doctor etc.

Phone No.
In the case of an emergency, please provide the best number for optimum contact at any time of day or night.