National Conference

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

March 21-22 2011 - Melbourne

   Registration and Payment Form   


Please provide the following contact information

Name
Title
Organisation
Work Phone
Fax
Email
 Address
Address 
City
State
Postcode
Country

Please describe your current role and your interest in this event:


TYPE OF REGISTRATION 

Fee (includes GST)

Individuals and families (self-funded) $88
Groups (self-help, advocacy, community) $220
Service providers, practitioners $440
Academics, researchers $440
Commercial (trainers, consultants, planners) $550
Government $660
Sponsors Free
One day registration is available at 66% of the applicable rate


I will be attending as a

         
 

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.

 
 


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 11 March, 2011. For cancellations received after 12 March, full fees will apply.
4. Transfer of registration is permitted where necessary, to enable another person from the same organisation/department/group 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.)
5.. Privacy Statement: Registration details will be held in the strictest confidence and will not be passed onto a third party without the express permission of the attendee.

Social Enterprise Partnerships Ltd
ABN 47108742098
PO Box 159
Yarraville Vic 3013