AMAC – QLD July 2017
Educational Seminar & AGM
Title: “Points About the Joints”
Dates: Saturday 29th to Sunday 30th July 2017
Venue: QT Gold Coast
Address: 7 Staghorn Ave, Gold Coast, Qld, 4217
Ph: 07 5584 1200
REGISTRATION FORM
NAME:
ADDRESS:
Ph:
Fax:
Mob:
E-mail
CPD/ACRRM No:
Registration fee (GST included):
(Please tick box)
AMAC Members Early
Bird
AMAC Members after
July 1st, 2017
Non-Members Early
Bird
$ 495.00
Non-Members after
July 1st, 2017
Committee
Member/Student Fee
$ 858.00
( Dinner to be paid in advance with registration )
How many:
$72.00
Dinner will be the Buffet at the Bazaar Restaurant, QT Hotel
Total
Registration fee includes Morning &
Afternoon tea and Lunch on both days
No registrations will be taken after
July 22nd, 2017
Dinner Attendance:
Yes
No
$ 572.00
$ 748.00
$ 250.00
Per person
Special Dietary Requirements:
Payment method:
A.
Please forward this Registration Form and your Cheque (payable to AMAC-Q) to:
Julie Hill, P.O. Box 1052, Noosaville DC. Qld 4566 Phone: 0439 549 085 Fax: 07 54424140
B. Log on to www.amac.org.au to register online
C.
E-mail or fax your form to address below and direct deposit to:
Australian Medical Acupuncture College BSB: 084 462 Acct No: 83 791 5608
Please be sure to put your First Name and Surname
D. Name on Card:_______________________________________ Card type: Visa / MasterCard / Amex
Credit Card Number:__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiry Date:_ _ / _ _ CVV No: _ _ _ _
Signature: _______________________________________
TOTAL AMOUNT PAID: $______________
Please direct any inquiry to: Julie Hill, Qld Administration Officer, Phone: 0439 549 085
Fax: 07 5442 4140 E-mail: [email protected]
Australian Medical Acupuncture College
A.C.N. 006 101 613 A.B.N. 49 006 101 613
AMAC – QLD July 2017
Educational Seminar & AGM
Statement of Consent:
I confirm that I have read and understood the attached information.
Option 1: I consent to taking part in practising acupuncture skills. I understand that I can opt out
at any time.
Print name in full: ________________________________________________________________
Signature: ________________________________________________Date: __________________
Option 2: I don’t consent to taking part in practising acupuncture skills.
Print name in full: ________________________________________________________________
Signature: _________________________________________________Date: _________________
Australian Medical Acupuncture College
A.C.N. 006 101 613 A.B.N. 49 006 101 613
AMAC – QLD July 2017
Educational Seminar & AGM
AMAC Meeting Registrant Consent Form


Australian Medical Acupuncture College (AMAC) will provide opportunities to insert needles into fellow
Registrants, as well as to experience the insertion of acupuncture needles, during the workshops. This will
be a great opportunity to develop and practise needling skills and all Registrants are encouraged to
participate.
AMAC may also offer laser acupuncture as an alternative/ standalone option for those that are strong
reactors, or have vasovagal reactions with needling.
However, this is not compulsory, and you have a choice to accept or to opt out and not take part in the
needling or laser acupuncture practice.
In making the decision to practise or opt out of needling and being needled, lasering and being lasered, it is
important to understand the possible adverse effects of acupuncture. These include:
 drowsiness after treatment in a small number of patients. If you experience this you are advised not to
drive or operate machinery until this effect passes;
 minor bleeding or bruising after acupuncture in about 3% of treatments;
 pain during treatment in about 1% of treatments;
 existing symptoms can get worse after treatment (less than 3% of patients), although this is usually a
good sign;
 fainting in certain patients, particularly at the first treatment.
 rare risk of infection, particularly in auricular acupuncture, immunosuppression, cardiac valve lesions,
implantable medical devices/prostheses, skin infections and dermatoses
 possibility of photosensitivity
 possibility of hypoglycaemia in susceptible patients, such as those with diabetes mellitus
It is also compulsory that you let your facilitators know if:
 you have ever experienced a fit, faint or funny turn;
 you have a pacemaker or any other electrical implants; if you have a bleeding disorder; if you are taking
anti-coagulants or any other medication;

you have damaged heart valves or have any other particular risk of infection;

you have Hepatitis B, C, immunosuppression, HIV or other infectious disease;
 you have any implants (joints or other).
 you are pregnant
 you have a needle phobia
 you have a photosensitive disorder
 you have diabetes mellitus
 you have an acute concurrent illness of any sort
 you have a chronic illness, not mentioned above, that you feel may have an impact on your either being
needled, lasered or needling and lasering.
Single-use, sterile, disposable needles are always used during teaching sessions and this is a common
accepted rule for all medical acupuncturists.
The use of lasers in demonstrations will conform to AS/NZS 4173:2004 Guide to the safe use of lasers in
health care and AS/NZS 1337.4:2011
Eye and face protection - Filters and eye protectors against laser radiation (laser eye-protectors)
Suitable portable massage tables, supplementary water, and confectionery will be supplied for the
statistically predicted 2 vasovagal reactions, and 2 hypoglycaemic reactions.
The acceptance of being a volunteer for demonstration of medical acupuncture techniques does not constitute
a therapeutic relationship (Legal advice via AVANT and TressCox Solicitors). It constitutes an Educational
relationship and is covered by AMAC’s public liability insurance, Directors and Officers Insurance,
Australian Medical Acupuncture College
A.C.N. 006 101 613 A.B.N. 49 006 101 613
AMAC – QLD July 2017
Educational Seminar & AGM
Professional Indemnity Insurance, AVANT’s medical indemnity (check with your insurer if not protected by
AVANT).
Australian Medical Acupuncture College
A.C.N. 006 101 613 A.B.N. 49 006 101 613