PAC 2010 Registration Form

Date: 02-Sep-2010
Capacity: 120 (0% booked)

Details

Dates:	2-4 September 2010
Time:	10am (Day 1)
Venue:	The Hyatt Hotel Canberra
Address:	Commonwealth Avenue, Yarralumla, Canberra

Please fill in the form below to register for the event. Please note: Cancellations within 8 weeks of conference are non-refundable.

* Required

Title

First Name *

Last Name *

Email Address *

Home Address *

City *

State *

Zipcode/Postcode *

Country *

Home Phone Number *

Enter Word Verification in box below *

I am attending as a: *
APLS Instructor ($100)
Non-APLS Instructor($350)

Name of other professional

Conference Functions:
Conference Dinner (cost $95)
Conference Cocktail Fuction

Partners name if attending:

Dietary Requirements:

Accommodation Request
The Hyatt Canberra ($275/night)
Rydges Lakeside ($175/night)
No accommodation required

Check In Date:

Check Out Date:

Number of People:

Advanced Paediatric Life Support Australia.

59 Victoria Parade Collingwood VIC 3066. Phone +61 3 9412 9222. Fax +61 3 94159622