2022 IAHA National Conference Sponsorship Application Form

Personal Details

Name*

Prefix First Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Territory Post Code Country

Mobile Phone*

Email*

Enter Email Confirm Email

Emergency Contact

Name*

First Name Last Name

Relation to Self*

Phone*

Scholarship Acceptance

Please be sure you have read the 2022 IAHA Professional Development Scholarship Terms and Conditions. You can view a copy here.

Scholarship Acceptance Declaration*

Please tick both boxes to indicate acceptance.

I accept the IAHA Professional Development Scholarship and I have read and agree to the IAHA Professional Development Scholarship Terms and Conditions
I agree to attend all sessions and events covered by my scholarship

IAHA Travel Form

IAHA’s policy is to book the cheapest available flight on the day however we will try our best to book flights convenient to you. Your flights will be booked for you to arrive at [LOCATION] on [DATE] and depart [LOCATION] on [DATE] following the AGM if possible, or if not, [DATE]. It is possible to request flights outside these dates but any additional accommodation required will be at your own cost. If you wish to travel outside these dates please make notes in the comments section.

Would you prefer to travel*

Morning
Afternoon

Would you be willing to take ‘red-eye’ flights if necessary?*

Yes
No

Airport Departing From

Airport Returning To

Comments

Please comment here if you require a mode of transport other than a plane, if you have any special requirements or requests, etc.

Specific Dietary Requirements

Please select your Accommodation Preferences*

I will not require accommodation arrangements to be made (staying with family or friends)
I will require accommodation

Comments

Declaration*

Please tick to indicate acceptance.

I give permission for IAHA to make travel and accommodation bookings for me, based on the information I have provided in this form, I agree that any costs incurred by making changes to these bookings will be at my expense, I agree to pay for any additional accommodation expenses incurred such as mini bar, movies, telephone calls, room service and internet.

Email
This field is for validation purposes and should be left unchanged.

Personal Details

Emergency Contact

Scholarship Acceptance

IAHA Travel Form

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