My Vote Counts Gathering Accommodation

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First Name/s*

Last Name*

ID Number*

Email Address*

Phone Number*

Home Address*

Do you require accommodation?*

Will your organisation cover all your travel costs to and from the gathering?*

If yes is selected, kindly book your own flights/shuttles.

Special Dietary Requirements*

Special requirements or accessibility needs*

Emergency Contact Name*

Emergency Contact Number*

I hereby agree to the terms and conditions.

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