2013 SSPA National Convention-Tasmaina Personal Information Question Title * 1. Please list your first name Question Title * 2. Please list your surname. Question Title * 3. What is your gender? Female Male Question Title * 4. Please select which age category applies to you? Under 3 3 to 12 13 to 17 18 to 29 30 and over Question Title * 5. Which state or territory do you live? Please select other if you're an international visitor ACT NSW VIC QLD SA WA TAS NT Other (International Guest) Question Title * 6. At what email address would you like to be contacted? Question Title * 7. Do you have a condition of dwarfism? Yes No Question Title * 8. Are you a current SSPA Member? Yes No Question Title * 9. Do you have any special dietary requirements?If so, please detail: Question Title * 10. Do you require a lower bunk bed for sleeping? Yes No Question Title * 11. Do you use a CPAP Machine for Sleep Apnea? Yes Question Title * 12. Do you use a wheelchair or scooter? Yes Question Title * 13. Do you require any assistance on/off the bus? Yes No Please list here the type of assistance you need Question Title * 14. Do you wish to hire Linen? ($17 per person) Yes Question Title * 15. Will you be attending all six days of the convention in full? Yes No Next