Refugee Week Talk and Tour, Rockdale Library - Registration Form
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First Name *
Last Name *
Preferred Name
How do you identify? (or gender identity) *
Legal Sex (stated on current birth certificate) *
How would you like to be referred to? (or pronouns) *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Country of Birth *
Ancestry *
Language/s spoken at home *
Required
Length of time living in Australia *
Arrival date *
MM
/
DD
/
YYYY
Migration stream/visa *
Relationship status (includes same sex) *
Phone *
Email *
Emergency contact name *
Emergency contact - Relationship to you *
Emergency contact phone number *
Consent to use your personal information
The information that you provide on this form includes your personal details and is used by Advance Diversity Services (ADS) for identification purposes. As part of the services provided to you by ADS, we need to collect information to assist Australian Government Departments to conduct performance reporting and research relating to the services that you receive. Your personal details are protected by law, including the Privacy Act 1988.
Information consent *
Consent to use media
Photographs and filming may take place during sessions. This material may be used in our publications or in media reporting for example the local newspaper.
Media consent *
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