PSA Annual Women's Conference 2008

Registration Form
* Indicates compulsory field
Please register me for the PSA Annual Women's Conference to be held on 11/12 September 2008.
I am a	Women's Councillor/Central Councillor  Elected Delegate from workplace Group  Member
PSA Membership No.*
Please list other PSA training/conferences you have attended and/or details of other union activities you have been involved in
Personal details
Name*	Given name Family name
Year of birth	1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Home street address*	No. Name AvenueCourtDrivePlaceRoadStreet--------------AlleyArcadeBendBoulevardChaseCircleCircuitCloseCrescentEntranceEsplanadeFreewayGardensGladeGlenGroveHeightsHighwayHillKeyLaneLoopMallMewsParadePromenadeRetreatRiseRowSquareTerraceTrackTrailWalkWayWyndOther
Town/suburb	Town/suburb State VICNSWQLDSAWANTTASACT
Postcode
Tel. home
Fax
Mobile
Work details
Your work address is required so that the letter requesting your Special Leave is forwarded directly to your employer.
Department/School/Authority
Att	Human Resources  Leave Clerk  Principal
Work street address*	No. Name AvenueCourtDrivePlaceRoadStreet--------------AlleyArcadeBendBoulevardChaseCircleCircuitCloseCrescentEntranceEsplanadeFreewayGardensGladeGlenGroveHeightsHighwayHillKeyLaneLoopMallMewsParadePromenadeRetreatRiseRowSquareTerraceTrackTrailWalkWayWyndOther
Town/suburb	Town/suburb State VICNSWQLDSAWANTTASACT
Postcode
Tel. work
Email
Job title
Special requirements
The below requirements need advance notice. Please apply ASAP for the arrangments to be made for you:
Do you require childcare?	no  yes
Child's name and age
Please indicate any special needs
Do you require a sign interpreter?	no  yes
Please note any special dietary needs
I have read the Criteria For Approval and agree to conditions	no  yes
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Your information will be kept strictly confidential and will not be passed on to any other organisation.