NSWHLF2007 Registration Form

Please complete a new form for each delegate attending from your organisation.

Early bird (until 28th September 2007) - $100 inc. GST **INCLUDES ENTRY INTO PRIZE DRAW**
Standard rate (after 28th September 2007) - $125 inc. GST
Accepted speakers - $75 inc. GST

Delegate details	* REQUIRED FIELDS
* Name:		Preferred name on badge:
Organisation:
* Email:		* Phone:
Attending the NSWHLF2007 as a:
Attendee type:
If "other":
Which sessions will you be attending? (registration fee does not change)
		YES	NO
DAY 1 Thursday 8th November 2007 *
DAY 2 Friday 9th November 2007 *
Forum dinner - Thursday 8th November *
Please note: the forum dinner is included in the registration fee, proudly sponsored by EBSCO. Do you have any special dietary requirements? Eg. vegetarian/gluten free
Who should the tax invoice for payment of registration fees be mailed to? Payment is NOT required now (although your authority to request an invoice to your organisation is). NSCCH will send a tax invoice for payment of registration fees within 2 weeks of receipt of your registration.
* Contact name:
* Organisation/Area Health Service:
* Mailing address:
* Phone:
* Fax:
* Email:
Order number (if req'd by you):

Declaration: I have sought permission to attend the NSWHLF2007 and request an invoice for the registration fee. Yes, I have permission *

Questions? Please contact Suzanne Reith-Wood (4320 3610) or Lisa Cotter (4320 3859)

Forum Registration