REGISTRATION FORM / TAX
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.
Discipline: Please select ...
State: Please select ... Post Code:
Phone: Mobile: Fax:
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
I understand the Cancellation and Refund Policy and accept these conditions.
Please email completed form to PTVEnquiries@austin.org.au
Workshop Enquiries to: firstname.lastname@example.org Accounts Enquiries to: email@example.com
PTV, Coral Balmoral Building, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights 3081