Complete this registration form to attend the Permaculture Design Course PDC 2018. Please note that if couples/families are attending this course, each person will need to register on separate forms. All information is confidential. * symbol indicates that you must answer the field, otherwise the form will not submit.RM_StatsUsername *Password *Password must be at least 7 characters long.Enter password again *Password must be at least 7 characters long. First Name *Last Name *Phone number *Email *Address Address Line 1 Address Line 2 City State or Region Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and the McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iraq Iran Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania, United Republic Of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Zip Name of person/s you are attending the course with (if applicable):Will you be flying to Cairns to attend this course? * Yes No Maybe Will you have your own car/transport? * Yes No Maybe If you have transport, could you provide a spare seat to another student if needed? * Yes No Maybe Next of Kin List the details of the person who may be called in the case of an emergency: first name *Last Name *Phone number *Email More About You Full name/s of children (if) attending and any additional information:Have you attended a Permaculture Design Course before? Yes No If so, please provide the details below:Who did you study with, where and when? What was the experience like?Write your reason for wanting to attend this course:What skills/knowledge do you already have regarding Permaculture?Tell us about yourself. What gets you out of bed in the morning? Catering/Dietary Requirements Please write your dietary requirements Ie gluten free, vegan, vegetarian etc *Food allergies? Please provide information for catering purposes Health Conditions If you have any health concerns, injuries or considerations, please make them known by writing them in the box below. *This information is confidential.Do you have any non-food related allergies, if so write the details below. * This information is confidential Accomodation Accommodation is included onsite at the Cairns Hinterland Stiener School (non-powered sites). You will need to BYO all camping gear or organise alternative accommodation. * Family Camping (quiet zone) Non-family (noise allowed) Not camping (sort alternative accommodation) Billeting - If you are a local attending the course, would you consider billeting accommodation to other students to stay with you? * Yes No Maybe If so, please use the Facebook page (you will be invited to upon registration) to let the others know and self organise. Ie. write an offer or request. Tours There will be 2 days of touring around the tablelands region to meet inspiring people and demonstration properties for hands on learning. How would you prefer to tour? * On the bus provided Meet you there, in my car In my car, carpooling spare seats with other students Skills of Trade There are jobs we need done during the course and before we outsource them, we would prefer to utilise the skills of the student group in exchange for a course discount. Do you have other skills for trade you would like to offer here? Payment Plans Payment plans are available, provided payment is made by the course commencement. A deposit of $350 is required to secure your place and weekly or fortnightly contributions with your names as reference. Contact us for the payment plan information. Payment Details Make sure you choose a payment option back on the original PDC page of website once you have registered. If none of those Paypal or credit card options suit you, then please make your direct debit to the bank details below, or contact us for other options. Edible Landscapes and Design Queensland Country Credit Union BSB 704640 ACCOUNT 64104084 REFERENCE You name I agree that I have read and understood the Important Course Information Page * Yes PDC course information link Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
