AZYC - BogSem '11 - Registration

Welcome to the online registration for BogSem '11.

BogSem has long been considered the apex of a boger's youth movement career, the height of interstate and trans-Tasman intellectual and social stimulation. And this year will be no exception.

So, start ironing out your chultzah, channelling your inner Golda, shotgunning space on your friend's couches, and booking your flights to Melbourne.

Cost and Reimbursement Information

Check out a draft of this year's exciting BogSem program. Please note, though, that the timetable and the content are still subject to a fair amount of change.

If you are unable to find a friend's bed to crash on during the seminar, please contact Ellie or Simon to sort something out.

Step 1: Personal Information
Your first name? *
Your last name? *
Your mobile number? *
Your email address? *
Are you a guy or a girl? *	Male Female
When is your birthday? *
What's your street address? *
Suburb? *
Postcode? *

Step 2: Movement Information
Which movement? *
Which Ken/Snif? *
What Shnat year?

Step 3: Medical Information [confidental]
Heart Disease	Yes No
Diabetes	Yes No
Hernia	Yes No
Epilepsy	Yes No
Anaemia	Yes No
Kidney	Yes No
Liver	Yes No
Peptic	Yes No
Asthma	Yes No
Mental	Yes No
Penicillin	Yes No
Allergies	Yes No
Operations	Yes No
Other	Yes No
Food Issues	Yes No
Medication	Yes No
Vegetarian	Yes No
Anaphalaxis	Yes No

Medicare Number *
Private Health Insurance
Private Health Insurance Number
Emergency Contact Name *
Emergency Contact Number *


STEP 4: REIMBURSEMENT (INTERSTATE GUESTS ONLY)
Note: If someone else has purchased a ticket to Melbourne on your behalf, please ensure you place their bank details and not your own in the reimbursement section. Also, you must email an electronic copy of your ticket to kesef@azyc.com to get your hard-earned money back. For more information on reimbursements, please contact Sam.
The full amount of your return ticket?
Your bank details for reimbursement? [BSB, Account No, Full Name]	BSB Enter bank details Account No Enter bank details Account Name Enter bank details

Step 5: Disclaimer
Print the disclaimer and send it back to us.	1. Download Disclaimer Form 2. Send to AZYC office, 306 Hawthorn Rd, Caulfield South 3162

All done? Click submit to find out how to pay and how much you'll get reimbursed by the AZYC.