DisengAGEd Conference Registration Form

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This is the registration form for the DisengAGEd Conference to be held on the 19th of May 2012 in Christchurch. This conference will deal with all sorts of issues based around why youth aren't getting engaged in civic and political processes (in both general and local body elections) and to try and find a youth-based fix for this. There will be a working paper presented to politicians and government after the conference detailing the ideas you guys come up with!

Find us on Facebook http://www.facebook.com/disengaged.chch for event location and details about speakers or email us at disengagedchch@gmail.com

UCPols is a non-partisan organisation located at the University of Canterbury, with an aim to get youth interested in the world around them www.facebook.com/UCPols

What is your name? *

How old are you? *

(This conference is aimed at the 16-24 age bracket)

What is your address?

What cellphone number can we contact you on? *

Which of the following applies to you?

Still at Secondary school

Left School but in Training

Gap Year

First Year Undergraduate at UC

First Year at another Tertiary Education facility

Other Undergrad Student

Post Graduate Student

Employed in Professional Industry

Employed in Trade Industry

Employed in other areas

Unemployed/Unwaged

Other:

Can you please let us know which of the following dietary requirements apply to you

(We will be supplying food during the conference so let us know any dietary concerns you may have!)

N/A

Vegetarian

Vegan

Peanut Allergy

Other Nut Allergy

Dairy Allergy

Gluten Free

Other:

For safety, what are the details of someone we can contact in an emergency? *

What is your email address? *

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