Conference Registration Form
Fill out the form to register for the Annual Scientific Meeting.
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Postal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Will you be attending the Welcome Reception?
Yes
No
Would you like to join the waitlist for the Gala Dinner?
Yes, if a seat becomes available I would like to attend.
No, I am not planning to attend.
Dietary Requirements
Registration Fee
*
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( X )
Member (Medical)
Including GST
$
1,840.00
AUD
Member (Allied Health)
Including GST
$
1,240.00
AUD
ACP Trainee
Including GST
$
1,340.00
AUD
Non-Member (Medical)
Including GST
$
1,940.00
AUD
Non-Member (Allied Health)
Including GST
$
1,340.00
AUD
University Student*
Including GST
$
240.00
AUD
Day Registration
$
770.00
AUD
Day
Friday
Saturday
Sunday
Monday
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Expiration Year
Submit
Should be Empty: