Darwin Convention Registration Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Title Given Names Surname Beefsteak and Burgundy Club member of(Required) Partner’s Name (if attending) Email address(Required) Phone(Required)Tick which of the following apply: Ordinary Member Life Member Committee Member First convention attended Committee member position held(Required) Accommodation(Required) Darwin Divas to organise Self to organise Attending Masterclass ($50 cost)(Required) Yes No Dietary RequirementsAccessibility RequirementsIn submitting this form, you agree that: You authorise your information – name and club – and any photos of you at convention functions to be shared with convention attendees and in the B&B News. Your contact details will be held in accord with the principles of the National Privacy Act (1988). You will pay the Registration Fee by the means and date(s) in the convention information provided. Δ
