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* 1. Your name:

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* 2. Your membership number:

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* 3. Which suburb do you live in?

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* 4. What is your postcode?

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* 5. What is your email address?

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* 6. What is your mobile number?

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* 7. Do you identify as an Aboriginal woman?

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* 8. Do you have special accessibility requirements?

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* 9. If yes, please provide further information here:

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* 10. Your employer:

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* 11. What is your job title?

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* 12. Please provide your Supervisor's name:

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* 13. Please provide an email contact for your Supervisor:

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* 14. Please provide your Supervisor's title for your leave letter:

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* 15. Please provide your workplace address:

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* 16. Have you attended a PSA CPSU NSW Women's conference before?

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* 17. Are you from Sydney Metro or a Regional area?

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* 18. If you are regional and your expression of interest is successful, will you require accommodation?

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* 19. If yes, do you require accommodation booked by the PSA or will you book your own accommodation?

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* 20. If you are from a Regional area and your Expression of interest is successful, will you require flights?

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* 21. Are you attending the Conference dinner? (This is held in the evening on Tuesday 3rd September and is open to all who attend the conference)

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* 22. Do you have any dietary requirements?

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* 23. If yes, please list your requirements here, for example allergies, intolerances and religious/cultural requirements:

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* 24. Why do you want to attend the PSA CPSU NSW Women's Conference?

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* 25. What do you want to get out of attending the PSA CPSU NSW Women's Conference?

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