Neuroplasticity in the Aquatic Environment Registration Form 2025

Registration and Payment Form

Please fill in the form below.
Neuroplasticity in the Aquatic Environment
Full Name*

PrefixFirst NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Special Needs - eg : Diet / Disability etc (we provide a vegetarian option only)
Previous undergraduate and postgraduate aquatic experience
Profession

Exercise PhysiologistPhysiotherapist
Attending

October 11th and 12th 2025 (EPs)November 8th and 9th 2025 (Physios)
Payment can be made via direct transfer to:

Account Name: Lisa Gilkes

BSB: 064 237

Account No: 10020123
A receipt will be emailed to you once registration and payment is complete. This confirms your place in the course.

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Registration and Payment Form