Group Relations Australia - Group Relations and Systems Psychodynamics

APPLICATION FORM - Disembodied Relations at Work

When registering multiple participants from the same organisation, please complete a separate application form for each attendee.

Title

Name *

First

Last

Age

Gender

Nationality

Work Role & Official Title

Email Address *

Please indicate any affiliations with group relations organisations

Full Member of Group Relations Australia Associate Member of Group Relations Australia

Are you a member of any related organisations? (e.g. AK Rice Institute, Group Relations India etc.)

How did you hear about this conference?

Please say why you would like to attend the conference, and what you hope to get out of it. *

Max 100 words

Please list any prior experiences of experiential group relations conferences (if any), giving dates, titles and locations and whether these were residential or online. *

Please outline qualifications, certifications and highlights of your work history that would be relevant to your application *

Max 300 words

Please attach a recent digitial photo in portrait style (Max 3MB. Preferably .jpeg file) *

Select Image

If you are applying for a multi-applicant discount, please provide the names of your colleagues who will also be attending.

Please indicate if you are wishing to apply for a partial bursary

I wish to apply for a partial bursary A number of partial bursaries are available to those unable to get full financial backing from their employers or other sources. If you have any questions, please email conference@grouprelations.org.au

Please supply supporting information for your bursary application (250 words)

Fees

Withdrawals / Cancellations before 19 January 2021: 90% refund. After 19 January 2021: No refund. Once your application has been received and accepted by the Conference Directorate, you will be sent an invoice for your fees outlining payment methods.

Earlybird fee (paid in full before 15 Jan 2021)

Standard fee (after 15 Jan 2021)

Discounts

$100 each for two or more employees from the same organisation

Agreement to participate

I have read the brochure for this conference in detail and apply to participate. I understand that this brochure constitutes the contract between Group Relations Australia and myself and that my application authorizes the organisation to conduct the conference in the manner described.

APPLICATION FORM - Disembodied Relations at Work

Fees

Agreement to participate

GROUP RELATIONS AUSTRALIA INC

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