* 1. I would like to attend the conference on July 4 2016

* 2. I am an associate

* 3. I am claiming an Early Bird Discount

* 4. I am claiming a free place as a  consultant/associate/partner

* 5. Order Number

* 6. My reasons for attending the event are as follows

* 7. Three learning outcomes I have for attending the course are:

* 8. Content I would like to see included in this conference includes:

* 9. I am able to offer examples of good practice in one of the following areas and I am willing to present or identify learners who can present

* 10. We would like to know where you heard about this event

* 11. I have additional needs and I have recorded my requirements below

* 12. Please add any additional information in relation to practice you can share, a speaker you want to recommended or the offer of student input/staff input

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