Welcome to Perfusion Downunder Winter Meeting 2011

PERFUSION DOWNUNDER WINTER MEETING 2011

Thursday 4th August 2011 – 6th August 2011

Hayman Island Hotel Pool

Hayman Island Resort

ONLINE FORM

Conference dates 4th to 6th August 2011

Register early as numbers may be limited
due to capacity of venue

*Fields marked with an asterisk (*) MUST be completed to send form!

Title:	* First and Last Name
* E-Mail address:
* Telephone Number:

* Qualifications:
* Department:
* Hospital/Centre:
* State/Province:
* Country:

* Address:

Facsimile Number:

Companion's Name:

International Registrants

PLEASE NOTE: All International registrants will need to apply for a Visa when coming to Australia.
(New Zeland registrants are the excpetion)

Please click here > > > for more information!

* Registration Fees (Please tick all that apply)

$AUD 745.00    - Full Registrant - Perfusionist
$AUD 600.00    - Subsidised Registrant - Student Perfusionist
$AUD 745.00    - Full Registrant - Scientist/ Surgeon/ Anaesthetist/ Nurse/ Allied Health
$AUD 495.00    - Companion Registration

Full Registration ($745.00) includes:

Thursday
Afternoon Tea
Welcome function dinner – including all beverages (wine, beer, soft drink)

Friday
Light breakfast
Morning Tea
Lunch
Afternoon Tea
Dinner – including all beverages (wine, beer, soft drink)

Saturday
Light breakfast
Morning Tea
Lunch
Afternoon Tea
Farewell dinner – including all beverages (wine, beer, soft drink)

** conference materials**
**abstract booklet**
** certificate of attendance**

Companion Registration ($495.00) includes:

Thursday
Afternoon Tea
Welcome function dinner – including all beverages (wine, beer, soft drink)

Friday
Light breakfast
Lunch
Dinner – including all beverages (wine, beer, soft drink)

Saturday
Light breakfast
Lunch
Farewell dinner – including all beverages (wine, beer, soft drink)

Payment Information
** Payment by Cheque:
(Please send cheque within 7 days or online application will be invalid!)

Cheques in Australian Dollars and made payable to:-
"Perfusion Downunder Pty Ltd"

Payment by Credit Card: Visa Mastercard
Card Number:
Expiry Date: Month/Year
Name on Card:

* Please Note: The launch fare of $150 per person and $75 per child under 13
will be included on your invoice on departure.

** Post cheques to:-
Bernardette Tackney, Cellplex Pty Ltd,
16-18 Hydrive Close, Dandenong South, VIC 3175
Fax No. +61 3 9799 7111, Telephone +61 3 9799 7444
E-mail: btackney@cellplex.net

Registrations may be limited due to capacity of the venue. Registrants must be primary practising clinicians. The Organising Committee reserves the right to accept or decline applications for registration.

Proudly sponsored by
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