Leadership – Authority – Power:
Exploring lateral & vertical relations at work
23-27 November 2015
REGISTRATION FORM
Please complete this form and email to Fred Wright, Conference Administrator
fredwright0203@gmail.com
Please complete a separate form for each participant when registering multiple
participants from the same organisation.
Information Privacy Policy:
A list of names, work organisation and role, and country will be compiled and supplied to all
participants. All other information will only be used by staff for allocation of participants into groups.
Participant details:
Title (Dr, Ms, Mr etc.):
First name:
Surname:
Work Organisation:
Work Role:
Email:
Mobile:
Phone (business hours):
Postal address:
City:
State:
Postcode:
Country (if outside Australia):
Leadership – Authority – Power:
Exploring lateral & vertical relations at work
23-27 November 2015
Please complete all of the following details. It will help in the formation of groups.
Gender (tick one box):
Female:

Male:

Age (please insert number): __ years
Are you a member of Group Relations Australia? (tick one box):
Yes:

No:
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Please describe in your own words any prior experiences of experiential group relations
conferences:
Please say what attracts you to the conference, and what you hope to learn:
Please note any specific dietary requirements:
Do you require disabled access?
Yes

No
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We advise applicants who are undergoing significant personal stress to postpone attendance, as
experiential learning conferences can, at times, be intensive and unsettling emotional experiences.
AGREEMENT TO PARTICIPATE
By registering for the Leadership – Authority – Power: Exploring lateral & vertical relations at work
experiential conference, I agree to participate in the conference as described in the brochure.
Signed: .......................................................................................................................................................
If you have any queries about your registration please contact:
Fred Wright, Conference Administrator
m: 0467 735 055 e: fredwright0203@gmail.com
Leadership – Authority – Power:
Exploring lateral & vertical relations at work
23-27 November 2015
Register and Pay in Full by 31 May 2015 to receive $150 discount on conference fee!
Registration includes participation in the conference, lunch, morning and afternoon teas each day,
and two evening meals. All fees are GST inclusive. Credit card payments incur a 3.5% administration
fee to cover bank charges.
Some bursaries are available to assist those on low incomes. Please contact the Conference
Administrator to discuss.
Conference:
Fee
Two or more employees from the same organisation
Group Relations Australia Associates and Members
less $150 discount (available until 31 May 2015)
Conference Registration Fee Total
$2,650
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$2,400
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$2,400
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-$150

$................
Accommodation options:
The following rates are for 4 nights, bed and breakfast, per person:
Single room with shared bathroom
$260
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Twin-share room with shared bathroom
$190

Please name the person you wish to share with .............................................................................
Single bedroom with shared bathroom, kitchen & lounge (8 only available)
$300

I am interested in accommodation at Carlton Vibe Hotel, Royal Parade

I prefer to make my own arrangements
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Accommodation Total
$................
TOTAL PAYMENT DUE (CONFERENCE AND ACCOMMODATION)
$................
Payment options
A Tax Invoice/Receipt will be issued following successful registration. If you wish to pursue other
payment options or apply for a partial bursary, please contact Fred Wright, Conference
Administrator.
1.
Electronic Funds Transfer
Payment can be made direct to the following Bank Account:
Group Relations Australia Inc ABN 78 408 951 695
Commonwealth Bank of Australia
BSB: 06 3262 Account No. 1031 9634

BIC/ SWIFT Code (for international transfers): : CTBAAU2S
Narration: PLEASE INCLUDE NAME OF ORGANISATION OR FULL NAME OF FIRST-NAMED
PARTICIPANT IN BANKING NARRATION DETAILS.
2.
Credit Card (Online through PayPal)

Please go to: www.grouprelations.org.au
to register your payment through our PayPal account.
Note: Credit card / PayPal payments incur a 3.5 % administration fee to cover bank charges.
3.
I require a Tax Invoice before payment can be processed
