To register for the 2018 Ulverstone, Tasmania Retreat please complete and submit the form below.

Full payment is required upon registration to secure your place.

Banking details:
Name: Alida MacGregor
BSB: 067 004
Account: 1002 4686

Name (required)

Email (required)

Mobile phone number

Home phone number

Work phone number


Emergency contact (required)

Emergency contact phone number (required)

Room allocation (select all that apply)

Are you a snorer and/or CPAP user?

Are you a smoker (note: smoking permitted OUTSIDE only)?

Preferred room mates

Do you have any disabilities or medical conditions we may need to be aware of, eg mobility limitations, epilepsy, allergies etc? If so, please provide details.

Special dietary requirements

We will do our best to assist with coordinating transport but no guarantees can be made until all traveller information is known

Own transportTransport to/from airport requiredTransport to/from ferry requiredI am interested in carpoolingOther (please specify)

Transport assistance
Please specify if you are able to assist with transport - number of seats available and pick-up location/s

Is there any other information you feel we should be aware of?