VAD Seminar Registration Survey

Event Registration Form

WA’s new Voluntary Assisted Dying Act 2019: Promoting Understanding for Culturally and Linguistically Diverse (CALD) People

Date: 12 October 2021

Time: 7.30am to 10.30am Australian Western Standard Time

Zoom: Details provided on registration

Location: William Street Family Therapy Centre Conference Room, 544 William Street, Mount Lawley 6050

Parking: Available on-street at Chelmsford Rd in front and across the road from William Street Family Therapy Centre, City of Vincent - Barlee St car park and Hyde Park on-street parking.

Please fill in the event registration form below to register to attend.

Event Information

1.What is your first name?(Required.)

2.What is your last name?(Required.)

3.What is your email address?(Required.)

4.What is your phone number?(Required.)

5.Do you work or volunteer in an organisation?

YES

If YES please advise the name of the organisation and your role.

6.Are you able to attend the seminar in WA in person? If not, you will receive a recording of the seminar by 26 October 2021.(Required.)

Yes

7.Are you an AfCAS member, a NAATI certified Interpreter/ Translator or student? (Please tick one)

AfCAS Member

NAATI Certified

Student

None of the above

8.Booking is essential - register at with a nominal fee of $10 ($5 for AfCAS Members, NAATI certified Interpreters and Translators, students)

Payments should be made to:
Account Name: AfCAS
BSB: 066000
Account No: 12399310
Reference: "Your Surname" and " VAD"

Once payment is received, you will registered

Confirm payment has been made (tick the following)?(Required.)

Yes money transferred

Thank you for registering for this event. We look forward to seeing you at the event.

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