2013 Professional Issues in Practice Conference
2013 Professional Issues in Practice Conference
2013 Professional Issues in Practice Conference
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<strong>2013</strong> <strong>Professional</strong> <strong>Issues</strong> <strong>in</strong> <strong>Practice</strong> <strong>Conference</strong><br />
Onl<strong>in</strong>e registration is available: www.t<strong>in</strong>y.cc/13profconf Registration closes on Friday 13 September.<br />
Surname<br />
Home address<br />
First name<br />
Postcode<br />
Workplace<br />
Workplace title/position<br />
Home ph Work ph Mobile<br />
Preferred email address ANF membership no<br />
Are you a member of NENA? Yes No<br />
Cost (all prices <strong>in</strong>clude GST) <strong>in</strong>cludes morn<strong>in</strong>g tea, lunch and afternoon tea<br />
Early Bird Registration: Register at www.t<strong>in</strong>y.cc/13profconf before 15 July and receive $50 off the onl<strong>in</strong>e price below.<br />
Onl<strong>in</strong>e registration - www.t<strong>in</strong>y.cc/13profconf Offl<strong>in</strong>e registration (us<strong>in</strong>g this form)<br />
One day ANF Job Rep/HSR $225 One day ANF Job Rep/HSR $250<br />
ANF / NENA member: $250 ANF / NENA member $275<br />
Non member $375 Non member $400<br />
Both days ANF Job Rep/HSR $325 Both days ANF Job Rep/HSR $350<br />
ANF / NENA member $350 ANF / NENA member $375<br />
Non member $675 Non member $700<br />
Method of payment (tick) Cheque Visa Mastercard<br />
Number Expiry date<br />
Name of cardholder<br />
Signature Amount enclosed $<br />
Where did you learn about this conference?<br />
Attendance: Day 1 only Day 2 only Both Days<br />
Please select the topics you wish to attend from the adjacent program and tick the appropriate box below.<br />
Note: topics <strong>in</strong> each l<strong>in</strong>e are all runn<strong>in</strong>g at the same time so please choose only one topic per l<strong>in</strong>e.<br />
Day 1 morn<strong>in</strong>g session<br />
followed by session<br />
1a<br />
2a<br />
1b<br />
2b<br />
1c<br />
2c<br />
1d<br />
2d<br />
1e<br />
2e<br />
Please advise if you<br />
have any dietary<br />
requirements or<br />
Day 1 afternoon session 3a 3b 3c 3d 3e allergies<br />
followed by session 4a 4b 4c 4d<br />
Vegetarian<br />
Day 2 morn<strong>in</strong>g session 5a 5b 5c 5d 5e Gluten Free<br />
followed by session 6b 6c 6d 6e Other requirements or<br />
Day 2 afternoon session 7a 7b 7c 7d 7e<br />
allergies:<br />
followed by session 8a 8b 8c 8d 8e<br />
(NB: Sessions 3e and 5a run for the full hour session. Do not choose a 4 or 6).<br />
All forms received via mail, email, fax or handed <strong>in</strong> to the office will be considered full price registration. Registration<br />
closes 13 September <strong>2013</strong>.<br />
Full payment must accompany all registration forms. Registrations will not be confirmed until payment is received<br />
Box 12600 A’Beckett Street PO , Melbourne 8006 or fax (03) 9275 9389<br />
Make cheques payable to “ANF (Vic Branch)”. Upon payment this form becomes a ‘tax <strong>in</strong>voice’. ABN 80571091192