APPLICATION FORM - Disembodied Relations at Work When registering multiple participants from the same organisation, please complete a separate application form for each attendee. Title * — Select — Mr Mrs Miss Dr Other Name * First Last Age Gender — Select — Male Female Other Rather not say Nationality Work Role & Official Title Email Address * Mobile Number * Phone (business hours) Postal Address * Address Line 1 * Address Line 2 City * State * Zip Code * Country * 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. * Max 200 words Please attach a brief CV (Max 3MB. No more than 2 pages) * Select File(s) 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) — Select — $1050 - GRA Associates & Members $1200 - Non-Members Standard fee (after 15 Jan 2021) — Select — $1200 - GRA Associates & Members $1350 - Non-Members 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. I have read and agree to the Terms and Conditions and Privacy Policy GROUP RELATIONS AUSTRALIA INC PO Box 2005,Brunswick East, VIC 3057 Explore Follow Us FollowFollow
