SA - Delegate Registration Form

A list of consenting delegates details containing your full name, organisation, state and email address will be shared with all sponsors and exhibitors leading up to the event and post-event. Please indicate your preference below to be in this list.

The details below will be used for name badge purposes. 

Please advise below if you have any dietary, medical or mobility requirements. If you have an allergy, please clarify if you are anaphylactic and carry an epi-pen. If you have no requirements, please leave these fields blank.

Your CHA membership number can be found in any CHA promotional email or in your official welcome email, sent from the Membership Team. If you are not a member and would like to become one, please contact the Membership Team at membership@continence.org.au