Pathology Update 2017
Registration Form
ABN 52 000 173 231
Online Registration is strongly encouraged via https://www.rcpa.edu.au/Events/Pathology-Update
TAX INVOICE - PLEASE KEEP A COPY OF THIS FORM FOR YOUR RECORDS
Speakers please do not complete this form. A Speaker Registration form will be sent to you.
Step 1: Delegate Details
RCPA ID (if known):_______________________________________
Prefix:__________ First Name:___________________________ Surname:__________________________________________
Workplace: _______________________________________________________________________________________________________
Work Address:____________________________________________________________________________________________________
_________________________________________________________________________________________________________________
City:____________________________________________________State:___________________P/code:_______________
Country:_________________________________________________ Telephone: (
)_______________________________________ Mobile: ___________________________________________
Email:____________________________________________________________________________________________________________
q Yes, Please update my RCPA Member Profile with the above details.
STEP 2: Registration Fees
All prices shown are in Australian dollars and include GST (Please 3 your requirements)
Early Bird Registration: on or before Thursday 2 February 2017
Full registration
1 Day registration
RCPA Fellow
q AUD $1023.00
q AUD $506.00
RCPA Trainee
q AUD $748.00
q AUD $374.00
Non-Member
q AUD $1122.00
q AUD $550.00
Late Registration: from Friday 3 February 2017
Full registration
1 Day registration
RCPA Fellow
q AUD $1287.00
q AUD $638.00
RCPA Trainee
q AUD $979.00
q AUD $495.00
Non-Member
q AUD $1408.00
q AUD $704.00
• Day registrants please tick which day you will be attending:
q Friday q Saturday q Sunday
Pathology Update 2017 - Schedule in Sydney
Step 3: Social Events at ICC Sydney
All delegates with a day or full registration are invited to the Welcome Cocktail Party and Awards Ceremony Soiree.
Confirmation of attendance is essential for catering purposes.
Delegate inclusive Social Events:
Date
Event
Cost
Attendance
Friday 24 February 2017
Welcome Cocktail Party
Inclusive
q Yes q No
Friday 24 February 2017
7.30pm - 9.30pm
Forensic Pathology Dinner with
Dr Andrew Baker
(only open to forensic pathologists and trainees)
AUD$88.00
q Yes q No
Saturday 25 February 2017
Awards Ceremony Conference Soriee
Inclusive
q Yes q No
TOTAL
$
Social Events for Guests:
Date
Event
Cost
Friday 24 February 2017
Welcome Cocktail Party
AUD $77.00
Saturday 25 February 2017
Awards Ceremony Conference Soriee
AUD $88.00
No.
Total cost
$
TOTAL
$
Step 4: Workshops: Confirmation of attendance is essential
Workshop
Date
Cost
Attendance
Workshop 1- Supervisors
Thursday 23 February
Inclusive
q Yes q No
Workshop 2- Digital Pathology
Thursday 23 February
Inclusive
q Yes q No
Workshop 3- Research
Thursday 23 February
Inclusive
q Yes q No
Workshop 3 Only - Research
Thursday 23 February
AUD$110.00
q Yes q No
Microbiology Trainee Mock Exam
Saturday 25 February
Inclusive
q Yes q No
Trainee Induction Afternoon
Sunday 26 February
Inclusive
q Yes q No
TOTAL
$
Step 5: Special Requirements- Delegate List and Catering
Privacy: Do you agree to your name and organisation being circulates to registrants and industry representatives?
Email addresses are not provided.
q Yes q No
Catering:
Please note all catering at the International Convention Centre Sydney will be Halal with Vegetarian and Coeliac
Options. Please tick if you require Kosher catering.
q Kosher
Pathology Update 2017 - Schedule in Sydney
Step 6: Total Registration Payment
All cheques and bank drafts must be in Australian Dollars and drawn on an Australian bank. Please make all cheques payable to:
The Royal College of Pathologists of Australasia and fill in the table below to determine full payment amount.
Your registration is not complete without inclusion of payment in full.
Registration Fee Total
AUD$
Social Events Total
AUD$
Workshop Total
AUD$
TOTAL PAYMENT DUE (includes GST)
AUD$
Credit Card Payment
Transactions will be made in Australian Dollars using the currency exchange rate of the day transaction. Therefore, the
amount shown on your monthly statement may be slightly different from our quoted due to currency exchange rate
fluctuations.
Credit Card (Please 3):
q Amex q Mastercard q Visa
qqqq qqqq qqqq qqqq
qq/qq
Card Number
Expiry date
Print card holder’s name:___________________________________________________________________________________________
Date:____________________________________________________
q Tax invoice required for employer payment
lease note to have a tax invoice created for your workplace to pay you need to complete a Registration Form first and then
P
email it to [email protected] or [email protected]
Please ensure Registration Steps 1- 6 are complete.
Confirmation of Registration
Online registrations will receive an automatic receipt. Please allow 7-10 working days for a manual registration receipt. Please
keep your receipt.
Cancellation Policy
This cancellation policy covers Pathology Update 2017 delegates who find themselves unable to attend the conference
after registering are most welcome to nominate a substitute. If this occurs, please advise the College as soon as possible.
Cancellations will only attract a refund in exceptional circumstances and must be requested in writing to the RCPA Events and
Sponsorship Manager Ms Eve Propper at [email protected]
No refunds will be given after Thursday 2 February 2017.
Pathology Update 2017 - Schedule in Sydney