Faculty of Life and Physical Sciences

SCIE2210 Registration Form 2008

Emergency contact person (Please provide their name, contact details and specify how they are related to you)
Your parent's name
Your home phone number

Are you traveling direct from Perth to Hangzhou? (If not, please indicate your intervening stop overs)
Do you intend to travel after the program finishes in mid December? (Please advise the details)
Please attach you Perth departure itinerary (Please name firstname_surname_departure.pdf)
Please attach your Perth arrival itinerary (Please name firstname_surname_arrival.pdf)
Do you have any special dietary requirements?
Do you take any medication or have any health issues that we should be aware of? (Please detail including the contacts of the practitioner who manages your condition)

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SCIE2210 Registration Form 2008

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