I will be attending in*

Sydney on Thursday August 17

          Sydney Exhibition Centre, Darling Harbour

Melbourne on Thursday August 24

          Melbourne Convention Centre

Perth on Wednesday September 27

          Perth Convention Exhibition Centre

First name*

Last name*

Job title*

Email*

Company name*

City*

Country

Telephone*

Facsimile

How did you hear about the conference?

Direct mail Email

Personal Referral or Referral from Accredited Practitioner

Other (please specify)  

Have you heard of Human Synergistics before? Yes No

May we contact you in future to send you more information about Human Synergistics? Yes No