Education Faces of MLD

The Premier Family Resource for Metachromatic Leukodystrophy Information & Support

 

MLD Family Conference™ Registration
Preston - Melbourne, Australia - Saturday March 19th, 2011

Click to see the Conference Overview or the Agenda

Online registration closes Friday March 11th.

Registration Instructions:
• Please fill out the form as best you can.
• Please let us know your arrival and departure dates even if you do not have travel reservations yet.
• Most families will arrive Saturday morning and depart after dinner Saturday night or Sunday morning. We start promptly at 13:00 Saturday.
• Please describe any special requests or dietary needs in the comments field.

Thanks! We look forward to seeing you in Preston - Melbourne!


Information About You
First Name
Family (Last) Name
E-mail
re-enter E-mail
Address
   
Address 2
   
City
   
State/ Province
Postal Code
Country
Phone
Hotel Reservation & Attendees
Adults

All adult registrations include conference materials, Saturday break & dinner.

STAYING AT HOTEL
Yes, staying at the hotel ... (rooming is not included in conference registration - contact Robyn Loh at the ALDS for details (03)98452831 mail@alds.org.au)
No hotel room ... we're staying elsewhere or live locally.

Additional non-MLD adults... in addition to yourself how many other non-MLD adults are attending with you?

List names of ALL attending adults here so we can prepare name badges:

We register your non-MLD children/youth here ... MLD affected are in the next section:
Youth & Children
(non-MLD)

youth or child eating ADULT MEALS (non-MLD)

child eating CHILDREN's MEALS (non-MLD)

Please list names and ages of all attending children & youth here so we can prepare their name badges:

Infants
<1 year old
MLD Affected Family Member(s) - please list even if they are not attending
MLD Family Member #1

Name:

Age:

 
MLD Family Member #2

Name:

Age:

attending?
Yes Unsure
No
 
attending?
Yes Unsure
No
wheelchair?
Fixed Folding No  
wheelchair?
Fixed Folding No
Birthday
Month
Day
Year
 
Birthday
Month
Day
Year
If Deceased, date of death
Month
Day
Year
 
If Deceased, date of death
Month
Day
Year
Therapy?  
Therapy?
eats regular meals?
Yes - adult size
Yes - child size
No
 
eats regular meals?
Yes - adult size
Yes - child size
No
Travel Arrangements
Travel Dates
Arrival:
Conference starts 13:00 Saturday the 19th.
Departure:
Conference ends 20:00 Saturday the 19th.


The hotel has extended our conference room rate if you wish to arrive earlier or depart later.

Transportation Rail Fly Drive
Travel Details

Please supply rail/air travel information if available:
Arrival Flight/Train #: time: Airline:
Depart Flight/Train #: time: Airline:

Comments -
(if you need scholarship help or have special dietary needs please indicate this here)

Please consider a donation to the MLD Family Conference scholarship fund to assist families that may not otherwise be able to attend the conference. Scholarship donations are tax deductible.
Yes No Would you like to add a modest 3% to your conference registration fees to cover our credit card transaction costs?

To make sure you are human and not a spammer, please enter the answer to the simple math problem above here:

<-- Click here to submit your registration and proceed to the payment screen.

Please note: Registrations are not complete until the registration fees are paid and all registrations are subject to the guidelines on the Overview page.