Registration South Coast Dieback Information Forum - June 11th 2015

Personal Details

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* 1. Please fill in your personal details

Name: *

Company:

Address 1:

Address 2:

City/Town:

ZIP/Postal Code:

Email Address:

Phone Number: *

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* 2. Where did you hear about the 2015 South Coast Dieback Information Forum?

South Coast NRM website

South Coast NRM email newsletter

Local paper

Radio

Word of mouth

Other (please specify)

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* 3. Will you be attending the 2015 South Coast Dieback Information Forum as:

An attendee

A presenter

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* 4. Please let us know about any dietary requirements you may have:

None

Vegetarian

Vegan

Gluten free

Other (please specify)

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* 5. The 2015 South Coast Dieback Advisory Committee Meeting is scheduled from 2.30-4.30pm at the same venue after the forum has finished. Will you be attending this meeting?

Yes

No

Maybe

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* 6. At the end of the forum there will be a field trip to a local Dieback site with Dieback expert Dr Joanna Young, leaving the Albany Entertainment Centre at 2.30pm and returning no later than 4-4.30pm. This field trip is now FULL. Would you be interested in a similar field trip to run on a day in the near future?

Yes

I'm not sure but keep me in the loop

No