Three Days in April

   
Consumer-Centred Health Care:
 Strategies for Implementing Transformational Health Reform


 

April 3/4/5 2017 - Melbourne

Registration and Payment Form 


I wish to register to attend: (please tick one, two or three boxes)

Day 1: Consumer and Carer Hubs in Mental Health

Day 2: Systems and Platforms for Consumer-Centred Health Care

Day 3: Opt-In Person-Centred Health Care Plans in Mental Health,
                  Chronic Illness, Disability, Ageing and Maternal Health

 
Please provide the following contact information

Name
Organisation
Phone
Email
 Address
Address 
State
Postcode


Please describe your current role and your interest in this event(s):


TYPE OF REGISTRATION 

Fee (includes GST)

  One
day
One
day
Member
CSA
Two
days
One
day
Member
CSA
Three
days
One
day
Member
CSA
Individuals, consumers [self-funded] $88 $55 $110 $88 $121 $99
Groups - self-help, consumer, community [self-funded] $99 $77 $154 $132 $187 $154
Services, agencies, practitioners, [government-funded] $275 $220 $495 $440 $572 $517
Academics, researchers $275 n/a $495 n/a $572 n/a
Commercial - trainer, consultant, planner $275 n/a $495 n/a $572 n/a
Corporate $550 n/a $770 n/a $880 n/a
Government $550 n/a $770 n/a $880 n/a

I will be attending as a

         

  I wish to become a member of Civil Society Australia and register at the member rate
  in the following category:         

Category of Membership - Civil Society Australia
 
Annual Fee
Individuals
Parents and carers; neighbours; consumers; volunteers; residents.
$10
Associations
Voluntary associations; circles of support; sporting clubs; churches and faith groups.
$20
Services
Schools; health organisations; community services.
$100


  Total amount payable  
 

Payment Options

Please reserve my place and
            
 
I will send my cheque/money order to  Social Enterprise Partnerships
PO Box 159
Yarraville VIC 3013
(Cheque payable to Social Enterprise Partnerships)
OR  
I will pay by EFT transaction:

 

 

Bank: Commonwealth Bank of Australia
Account name: Social Enterprise Partnerships Ltd
BSB: 062 218
Account number: 1007 2945
Please send a tax invoice.

I have read, and accept the terms and conditions described below.

 

Note: if you see an error message on submission of this form - disregard it,
your submission will be received.


Terms and Conditions
1. Registration fees must be paid in full before the date of the event.
2. Cancellations must be notified in writing by 24 March, 2017. For cancellations received after 24 October, full fees will apply.
3. Transfer of registration is permitted where necessary, to enable another person from the same organisation to attend the event in place of the person whose name is shown on the registration form. (Should you wish to take up this option, please advise  on the change of name and contact details before the date of the event.)
4. Civil Society Australia reserves to right to accept or reject participants in these events/processes as it sees fit.

Social Enterprise Partnerships Ltd
for Civil Society Australia
ABN 47108742098
PO Box 159
Yarraville Vic 3013