AVA Membership Number (Please contact members@ava.com.au if your membership has lapsed)
	AVA Membership Number (Please contact members@ava.com.au if your membership has lapsed)

	Prefix (Mr, Mrs, Dr etc)*
	Prefix (Mr, Mrs, Dr etc)

	First Name*
	First Name

	Last Name*
	Last Name

	If you want your pronouns to appear on your conference badge, please enter them here
	If you want your pronouns to appear on your conference badge, please enter them here

	Email Address*
	Email Address

	Company*
	Company

	Job Title*
	Job Title

	Mobile Phone*
	Mobile Phone

	Address Line 1*
	Address Line 1

	Address Line 2
	Address Line 2

	City*
	City

	State*
	StateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaOther/non-AU