Privacy Collection Notice: The information on this form is being collected by the Melbourne CSHE or LH Martin Institute. You can contact us on +61 3 8344 4605 or melbourne-cshe@unimelb.edu.au for the Melbourne CSHE, or +61 3 8344 0756 or martin-institute@unimelb.edu.au for the LH Martin Institute. The information is being collected in order to complete your registration in our professional development program or record your attendance in our event. The information will be used by authorised staff for the purpose for which it was collected and will be protected against unauthorised access and use. 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. You may access any personal information you have provided to the University by contacting 13 63 52. The University of Melbourne is committed to protecting personal information provided by you in accordance with the Privacy and Data Protection Act 2014 (Vic). All information collected by the University is governed by the University’s Privacy Policy. For further information about how the University deals with personal information, please refer to the University’s Privacy Policy or contact the University’s Privacy Officer at privacy-officer@unimelb.edu.au.
Title*
First name*
Last name*
Preferred name
Gender*
Faculty/Division*
Student ID
Student username (e.g. jsmith)
Degree Type
Candidature stage
Preferred email address*
Contact phone number
How did you hear about the program/event?*
Dietary requirements (for catered programs only)
Special requirements (e.g. venue accessibility)
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