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 Thursday 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)