Plastic Surgery - Association of Plastic and Reconstructive Surgeons ...
Plastic Surgery - Association of Plastic and Reconstructive Surgeons ...
Plastic Surgery - Association of Plastic and Reconstructive Surgeons ...
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Registration FormPlease complete <strong>and</strong> return to: 2011 PSC SecretariatC/ – Conference Action Pty Ltd, PO Box 576, CROWS NEST NSW 1585 AUSTRALIATel: +61 2 9431 8632 Fax: +61 2 9431 8677 Email: 2011psc@conferenceaction.com.auASPS ABN: 78 823 025 148Section A: DelegateALL FIGURES ARE IN AUSTRALIAN DOLLARS AND INCLUDE GSTSurname: Title: Given Name:2011<strong>Plastic</strong> <strong>Surgery</strong>CONGRESSOrganisation:Position:Address:Suburb: State: Country: Postcode:Telephone: ( ) Facsimile: ( )Email: (Required for your confirmation details)Dietary Requirements: (Lactose intolerant, gluten free, dairy free, etc.)Before or After PaymentSection B: Registration Fees on 30/4/11 30/4/11<strong>Plastic</strong> <strong>Surgeons</strong> ASPS & NZAPS Members Full Congress $1,200.00 $1,400.00 $One Day $440.00 $550.00 $Non Members Full Congress $1,400.00 $1,600.00 $One Day* $550.00 $650.00 $*One day delegates: Please tick () day <strong>of</strong> attendance Thu 7 July 2011 Fri 8 July 2011 Sat 9 July 2011 Sun 10 July 2011Research Fellows Full Congress $660.00 $770.00 $One Day* $350.00 $450.00 $*One day delegates: Please tick () day <strong>of</strong> attendance Thu 7 July 2011 Fri 8 July 2011 Sat 9 July 2011 Sun 10 July 2011SET Trainees <strong>and</strong> Residents Full Congress $660.00 $770.00 $One Day* $350.00 $450.00 $*One day delegates: Please tick () day <strong>of</strong> attendance Thu 7 July 2011 Fri 8 July 2011 Sat 9 July 2011 Sun 10 July 2011ExhibitorsIncluded in BoothSection C: Workshops & Training CoursesAdditional Exhibitor $350.00 $350.00 $TOTAL REGISTRATION FEES $Young Fellows Forum on Practice Optimisation Tue, 5 July 2011 Attending YES NORhinoplasty Pre-Congress Workshop Wed, 6 July 2011 $350.00 $400.00 $Supervisors <strong>and</strong> Trainers (SAT SET) Workshop Wed, 6 July 2011 Attending YES NOInterviewer Training Course Wed, 6 July 2011 Attending YES NOPractice Managers <strong>and</strong> Registered Nurses Course Full Congress $500.00 $550.00 $One Day* $200.00 $250.00 $*One day delegates: Please tick () day <strong>of</strong> attendance Thu 7 July 2011 Fri 8 July 2011 Sat 9 July 2011Training <strong>and</strong> Certification for Botox <strong>and</strong> Juvederm Sun, 10 July 2011 Attending YES NOTOTAL WORKSHOPS/TRAINING $
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