NT WOMEN'S HEALTHY COUNTRY FORUM & NETWORK - REGISTRATION
Completing this form is a two tiered process.We need to collect information about forum attendees so that we can organise logistics.The information that you provide will form the base for the data collection for the network, so please, even if you are unable to attend the forum, take a few moments to make sure you complete the form accurately so that we know that the right information is going to the right people.
Who are you completing this for:
A group
An individual
Other
Will you / your group be attending the Mimal 2019 NT Women's Healthy Country Forum?
Yes
No
Unsure
Other
About the organisation
Ranger group
Administrative organisation
Ranger email
example@example.com
Administrative organisation's email
example@example.com
Ranger Phone Number
-
Area Code
Phone Number
Administrative organisation's phone number
-
Area Code
Phone Number
Ranger base - Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Administrative organisation address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Postal address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
About the ranger group
We are seeking this information to understand the xxx of Indigenous women working in Healthy Country across the region
How many Indigenous staff work at the ranger organisation?
How many of these staff are Indigenous women?
How many Indigenous women are rangers?
How many Indigenous women are support staff?
How many are employed as full time?
How many are employed as part-time / casual?
Ranger programs
Could you please provide us your Healthy Country Plan and/or Land and Sea Management Plan?
Browse Files
Cancel
of
Do you have a career progression plan under your current ranger program?
Yes
No
Unsure
Could you please attach your career progression plan?
Browse Files
Cancel
of
Could you please provide your organisational structure?
Browse Files
(It can be in any format eg. organisation chart)
Cancel
of
Registration for forum
How many women from your organisation will be attending the forum?
Attendee 1
Attendee 1
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Submit
Attendee 1
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 2
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 3
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 4
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 5
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 6
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 7
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 8
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 9
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Attendee 10
Name
First Name
Last Name
Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address - if different from your organisation's
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been in this role?
Do you have any dietary requirements?
Do you have any medical conditions that we need to be aware of?
What is your T-shirt size?
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Do you identify as Aboriginal or Torres Strait Islander?
Yes
No
Unsure
Other
Back
Next
when is your estimated arrival
how will you be travelling to forum
do you require any assistance with camping gear
do you require any assistnace with getting to the forum
Should be Empty: