Stata I: Introduction to Stata by zK0gMhke

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									Introduction to Clinical Trials
Registration Form 2012
TAX INVOICE: ABN 21 006 566 972


1 day course


Dates:    27 September 2012                     Times:     Day 1: 9.00am – 5.00pm


NAME:

POSITION:

JOB TYPE: (mark 1 only)               Clinical                      Nursing
                                      Allied Health                 Social Science
                                      Lab Science                   Other:

STUDENT TYPE: (mark 1 only)           Master of Medicine            MD
                                      AMS                           PhD
                                      Honors                        Other:

DEPARTMENT:

ORGANISATION:

STREET:

SUBURB:                                                        POSTCODE:

PHONE NUMBER: (work)                                           (home/mobile)

EMAIL ADDRESS:

COST includes course notes.

Internal participants:                     $100.00**
External participants (inclusive of GST)   $320.00
External Full-time Students                $160.00

Payment by internal transfer:
If your RCH or MCRI department is paying your registration fee, please organise for your admin/finance
person to send a memo to RCH or MCRI Finance requesting a transfer from your department cost centre to
CM68092. Send a copy of the internal transfer request along with this registration form to CEBU.

Payment by cheque:
Please send a cheque, payable to Murdoch Childrens Research Institute, with this registration form to:
Clinical Epidemiology and Biostatistics Unit (CEBU), Murdoch Childrens Research Institute, Royal Childrens
Hospital, Parkville Vic 3052

Payment by credit card:
Card Type:
Holder:
Card Number:
Amex Security Code:
Expiry Date:
Amount:

** Fee applies to staff from MCRI, RCH, DOP & SPH only

Enquiries to Donna De Sair - Phone: 9345 6368: Fax: 9345 6000: Email: donna.desair@mcri.edu.au

								
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