9th Injury Prevention Conference

The 9th National Conference on Injury Prevention and Safety Promotion Registration Form


Personal Details

Title:

First Name:

Last Name:

Company Name:

AIPN Member:
Not Selected
Yes
No

SIA Member:
Not Selected
Yes
No

Member Number:

Position:

Preferred name for badge:

Partner's name for name badge (if attending):


Contact Details

Street No. & Street Name:

City / Suburb / Town:

State:

Country:

Zip / Postcode:

Daytime phone number:

Fax number:

Email Address:

Special Dietary Requirements:

Emergency Contact Name:

Emergency Contact Phone Number:

Mobile / Cell Phone number:


Registration Details

Early Bird Rate
Registration and payment received prior to 30 June 2009

AIPN/SIA Member - $645.00
Non Member - $695.00
Student - $300.00
Day Rate - $350.00

Full Rate
Registration and payment after 30 June 2009

AIPN/SIA Member - $695.00
Non Member - $745.00
Student - $300.00
Day Rate - $350.00

PRE-CONFERENCE WORKSHOPS

Understanding hospital morbidity coded data - $50.00

or

Water Safety Workshop - $50.00

Child Injury Prevention - $50.00

or

Tips for how to use coroner/medical examiner data and the National Coroners Information System' – session 1 - $25.00

Tips for how to use coroner/medical examiner data and the National Coroners Information System' – session 2 - $25.00

Evaluation: How Can we Do it Better? - $100.00

SOCIAL FUNCTIONS
Accompanying Person – Welcome Reception - $65.00
Conference Dinner - $80.00
Accompanying Person – Conference Dinner - $130.00

Please make a selection one or more of the Registration options:
AIPN/SIA Member
Non Member
Student
Day Rate - Monday 27 July
Day Rate - Tuesday 28 July
Workshop: Understanding hospital morbidity coded data
Workshop: Water Safety
Workshop: Child Injury Prevention
Workshop: National Coroners Information System – session one
Workshop: National Coroners Information System – session two
Workshop: Evaluation: How Can we Do it Better?
Accompanying person - Welcome reception
Conference Dinner - NGV
Accompanying Person – Conference Dinner

I will be attending Welcome Reception:
Yes
No


Cancellation Policy

Any delegate registrations booked will incur a 100% cancellation fee if cancelled within 30 days of the Conference dates. If your cancellation is received MORE than 30 days prior to the event, a cancellation fee of $100 will apply.

DISCLAIMER
The conference organisers reserve the right to change activities, topics and presenters where necessary. Monash University shall not be liable for any loss caused by the cancellation of the conference where such cancellation is due to Force Majeure. The term “Force Majeure” means any circumstance beyond the reasonable control of Monash University including but not limited to War, hostilities (whether war be declared or not), terrorism, aircraft hijacking, military operation, riot, civil war, rebellion, civil commotion or unrest, Acts or Regulations of government, refusal to grant visas, explosions, transport delays, transport difficulties and the insolvency of airline carriers. Monash University will use all reasonable efforts to conduct the conference despite the intervention or occurrence.


Completion & Payment

Purchase Notes:

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