SPINRPHEX & WAALHIIBE Rural Health Clubs
Annual SPINRPHEX/WAALHIIBE Conference
Teamwork works in Rural Health!
Registration Form
I wish to attend the Joint Conference held by SPINRPHEX and WAALHIIBE on Saturday, 31st August 2013
from 10:30am – 5:45pm.
Please print clearly
PERSONAL DETAILS
Name:
Email Address:
Mobile:
University:
DIETARY REQUIREMENTS
Vegetarian
Vegan
Halal
Course:
Year:
Lactose-free
Gluten-free
Other (please list)
Terms & Conditions
Confirmation of your registration and receipt will be sent via email. Please ensure you have
provided your email address. Registrations without payment will not be processed.
Delegates must sign the form to validate the registration.
CANCELLATION POLICY: Cancellations must be received in writing seven working days
before the event to receive a full refund of registration fees. Cancellations made after that
date cannot be accepted, however a transfer of registration to another person will be
accepted at any time. No refunds will be given to delegates who fail to attend the event.
Signature:
PAYMENT OPTIONS
Please submit this form in hand or via email to Cameron at [email protected]
or Heidi Greve at [email protected]. Payment of $20 to be submitted by one of
the following options:
1. Cash to Cameron Wagner at N Block (QEII Medical Centre) – Room G16 or Heidi
Greve at Rural Health West (Level 2/10 Stirling Highway)
2. Credit Card click the following URL to pay online via the UWA shopping cart:
http://payments.weboffice.uwa.edu.au/SPINRPHEX/payment
3. Cash to your SPINRPHEX or WAALHIIBE Representative
SPINRPHEX & WAALHIIBE Rural Health Clubs
Please phone Cameron on 9346 7324 or email him at [email protected] if you
have any queries about the conference or payment options.