Application Form

Aboriginal and Torres Strait Islander Suicide Prevention Conference

Please complete this form and email it to chrissie.easton@uwa.edu.au(Note that first round applications close 5.00pm Friday 31 March 2016).

Second round offers close 5.00pm Friday 15 April 2016.

Name:

Home address:

Phone number: Mobile number:

Email address:

Are you Aboriginal and/or Torres Strait Islander origin? Y NEmployer:

Position:

Why do you want to attend the conference and what do you hope to gain from the experience:(Max 200 words – this box will expand to accommodate your response as you type)

If you are not sure about what to write here, please ring Chrissie Easton on (08) 6488 1570 for assistance.