APPLICATION TO REGISTER

Women of Faith as Peacemakers

THE Sixth JCMA Women’s Conference 2012 for Jewish, Christian and Muslim Women

at The Edmund Rice Conference Centre~“Amberley”,

7 Amberley Way, Lower Plenty 3093. Melways 21-C12

Sunday 12 February to 3.00 pm Tuesday 14 February 2012

Registration 12.00pm – 1.00pm, Conference commences 1.00pm

I hereby apply to participate in the Sixth JCMA Women’s Conference for Jewish, Christian and Muslim Women to be held in Australia:

(Please complete; print clearly in capital letters, mark all appropriate boxes, and include your deposit.)

Family name: …………………………………………………Given name: ……………………………………………….

Preferred designation or title (Miss/Ms/Mrs/Rabbi/Reverend/Professor/Dr/other): ………….….

Please print my name on my name-card as: …………………………………….

Profession/field of work/study: ………………………………………………………………………..

My name, e-mail address & organisation MAY or MAY NOT be made available to Conference participants and to future JCMA activities 

Age: 18-3031-50over 50

Address: …………………………………………………………………………………………………

Town: ………………………………………… State: …………………. Postcode: ………………..

Phone: Work: …………………………………. Home: ………………………………………………

Mobile: ……………………………………………. Email: ………………………………………………

Fax: …………………………………………………………………………………………......

Religion: ………………………………… Denomination: …………………………......

All meals will be strictly vegetarian. Other dietary requirements: ………………………......

Transport assistance required: YesNo Transport assistance offered: Yes Number of places offered 

Accommodation: I request accommodation in:

Twin Room shared facilities @ $265 

(if possible sharing with………………………………..)

Twin Room ensuite @ $295 

( if possible sharing with………………………………..)

Single Room shared facilities @ $325 

Single Room ensuite @ $365 

Please note:There are very limited numbers of ensuite rooms.

They will be allocated in the order of applications received

I wish to apply for a Subsidy (see next sheet)

My cheque/money order covering the refundable* deposit of $50 is enclosed:

Please make cheques payable to ‘JCMA’.

Direct Debit: Jewish Christian Muslim Conference Bank NAB, BSB: 083 170, Account 580 969 036

Please email specifying your name and that this is a deposit for the Women’s Conference

*Deposits will be refunded to unsuccessful applicants and will also be refundable for cancellations until 30th January 2012

I have read, I and agree to the ‘Conditions of Registration’ as set out in the Conference Leaflet, which explains the balance we will be trying to achieve amongst conference participants. I understand and accept that if my application is successful, but the balance of my conference fee has not been received by the due date, that my registration may be cancelled and my place made available to another applicant.

Signed: ………………………………………………Date: …………………………………...

Completed applications must be posted by Friday 13 January 2012 to:

Rev. Dr Coralie Ling, Unit B 74 Blessington St St Kilda 3182 OR Email:

women of Faith as Peacemakers

THE Sixth JCMA Women’s Conference 2012 for Jewish, Christian and Muslim Women

Optional Registration Statement*

*This may assist in our decisions regarding allocation of places. If you are applying for a subsidy it is essential that you outline your situation for us below.

Please write a brief statement about why you would like to participate in the

Sixth JCMA Women’s Conference 2012

Your statement will remain confidential, and will be shredded following the conference.

Thank you.