Test 19-Nov-2021 18:28:PM Tets Trest I am registering for - Select -MyselfA Group Participant Details Title First Name Family Name Name for Nametag Gender Select GenderMaleFemale Date of Birth Country Select stateNew South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmania Institution or Organisation Location of Institution or Organisation Role Contact Details Email Address Mobile Emergency Contact Person Name Emergency Contact Relationship Emergency Contact Person Phone Number Medical Information (if applicable) Dietary restrictions? (Select all that apply) I do not have any dietary restrictions. Vegetarian Vegan Lactose Intolerant Gluten Free No Shellfish No Nuts Other (please specify) I give permission for the Trustees of the De La Salle Brothers and Lasallian Mission Council to publish or display identifying photos or recordings for the following purposes: The Lasallian District website (www.delasalle.org.au) Press releases produced by the Trustees of the De La Salle Brothers and Lasallian Mission Council Public Display Promotional Material for the Trustees of the De La Salle Brothers and Lasallian Mission Council Any printed or video publication produced by the Trustees of the De La Salle Brothers and Lasallian Mission Council Yes, I would like to receive updates from the Trustees of the De La Salle Brothers and Lasallian Mission Council Title YL RETREATS BOOKING REQUEST FORM
