Privacy Collection Notice: The information on this form is being collected by the Melbourne CSHE or LH Martin Institute. The information is being collected for the legitimate interest of completing your registration in our professional development program or record your attendance to our event. Your information may also be passed on to your institution, employer or sponsor for their staff development or sponsorship program reporting purposes. If you do not provide all the information that is requested on this form it may not be possible for us to book a suitable venue, provide special requirements such as dietary and access or prepare materials prior to the commencement of your program or event. For further information please read our Privacy Collection Notice, available at
First name*
Last name*
Preferred name
Faculty or division (if applicable)
Position Title*
Preferred email address*
Contact phone number
Dietary requirements (for catered events only)
Special requirements (e.g. venue accessibility)
How did you hear about the program/event?*
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