REGISTRATION FORM / TAX INVOICE

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					                                              REGISTRATION FORM / TAX
                                                    INVOICE
                                                     Austin Health
                                                 ABN: 96 237 388 063

                      Upon registration and payment this document becomes a Tax Invoice/Receipt.
                                Please retain a copy as no further receipts will be issued.

Name:

Discipline:       Please select ...

Organisation:

Address:

State:            Please select ...                  Post Code:

Phone:                                               Mobile:                            Fax:

Email:

Workshop          :                                                                     Date:

                          Registration Closes 10 days prior to the date of the workshop.

                  $220     General Registration
                  $200     Austin Staff                               Employee No:
                  $200     Aust. Assoc. of Social Workers:            Membership No:

Method of Payment

   Cheque/Money Order                 (Please make cheque or money order payable to Austin Health)

   Visa                Mastercard           BankCard

Name on Card:                           Credit Card No:

Expiry Date:                            Authorised Amount:

Signature of Card Holder:

Cancellation and Refund Policy
10% of registration fee forfeited if cancellation received before closing date.
50% of registration fee forfeited if cancellation received more than 48 hours before the program.
100% of registration fee forfeited if cancellation received less than 48 hours before the program or for non-attendance.
Cancellations must be received in writing. Post Trauma Victoria reserves the right to cancel this workshop with full
refund.

I understand the Cancellation and Refund Policy and accept these conditions.

Signature:                                           Date:

Please email completed form to PTVEnquiries@austin.org.au
Workshop Enquiries to: donna.zander@austin.org.au   Accounts Enquiries to: mary-anne.osborne@austin.org.au
          PTV, Coral Balmoral Building, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights 3081

				
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