First Name *

Last Name *

Email *

Phone *

Is there anybody you would like to be seated with?

There will be plenty of opportunities to put questions to our speakers at this event however if you’d like to submit a question in advance, please do so in the space below:

Please advise if you have any dietary requirements or food allergies:

PHOTOGRAPHY DISCLAIMER
Please be advised that photographs may be taken at our events and later used for our communication and promotional purposes.

Do you consent to have your photo used in AMA Victoria marketing and communication campaigns? *

If you responded no, please introduce yourself to the event organiser at the event and let them know you do not consent to photographs. We will then introduce you to the photographer and make sure that they are aware of your wishes.