AISSGA 2019 INTERSEX PEER SUPPORT CONFERENCE -- REGISTRATION FORM
This year's conference will be a retreat style weekend away together in Daylesford, 1.5 hours drive from Melbourne. A free bus transfer from the MEL Airport and also North Melbourne Train Station leaving on Friday 27/9 and returning Monday 30/9. Basic dorm-style accommodation and lush catering will be provided.
Mobile Phone Number
Are you ... ?
a person with an intersex variation
another family member not mentioned above
a facilitator or session presenter
Are you ...?
Over 18 years old
If you are booking for multiple people, who else will be coming? Please list the ages of children.
Are you a current AISSGA Member?
Where are you travelling from? (City/Country)
Where did you hear about the conference?
Emergency Contact Information - Name:
Emergency Contact Information - Relationship:
Emergency Contact Information - Phone:
I will be attending:
The whole conference: Fri-Mon
Family Program: Lunch Sat-lunch Sun
Not sure yet
TRAVEL TO DAYLESFORD
Every effort will be made to arrive at the pickup/dropoff at the stated time but you should be generous when booking your flights to accommodate unexpected delays. If you miss the bus, you can catch a train to Woodend and then a VLine bus to Daylesford and someone can pick you up from there.
Please nominate your preference:
PICK UP Friday 27/9
12:30 pm North Melbourne Train Station
1:00 pm Melbourne Airport (Tullamarine)
I'll make my own way there
DROP OFF Monday 30/9
2:00 pm Melbourne Airport (Tullamarine)
2:30 pm North Melbourne Train Station
I'll make my own way back
A very small travel bursary to assist with airfares from within Australia is available to those members who have a current health care card - who are experiencing financial hardship, currently unwaged or receiving Centerlink payments (Senior/DSP/Newstart)
Do you require access to this bursary?
Health Care Card Number and expiry date:
We are going on camp!
Accommodation is at an established activity center and will be very basic dorm-style, with 4-5 beds per room. BYO linen, pillows, and sleeping bags.
The following options are just in case you have specific requirements which we will try to accommodate:
Do you have special accommodation requirements? ... (select multiple):
Our family wants our own room.
I need my own room
I want to share with a particular person?
All meals will be provided. We will be preparing the food ourselves onsite. There is a store in Daylesford (5 mins away) if you require special for yourself or someone special...
Food allergy (add details in 'Other' below)
We are open to suggestions on what activities to hold over the weekend. There will be plenty of opportunities for social connection. The venue can facilitate physical activities such as bush-walking or horse riding for us. Also a Psychologist with a speciality in intersex issues will be present throughout the conference.
Is there anything in particular you want to get out of the weekend or to talk with others about?
Would you be interested in going horse riding over the weekend?
NOMINATION FOR AISSGA COMMITTEE
We will hold our AGM during the conference at 2pm on Sunday 29 September. If you are interested in (re)nominating for a position please indicate which role(s):
Aged Care Rep
As you know, we are a small community group run by peers who are not trained counsellors. While every care will be taken, by submitting this form you agree to take responsibility for your own person, belongings, health and personal expenses whilst at the conference and release the AISSGA and its committee from any liability that could arise. The AISSGA has full Public Liability Insurance coverage. If you require at any assistance, at any time, please ask for help :)
I agree to the daggy AISSGA disclaimer
Send me a copy of my responses.
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