Registration Conference Form by ics15473

VIEWS: 0 PAGES: 6

More Info
									                                                                                OCCUPATIONAL THERAPY AUSTRALIA
                                                                                24th National Conference & Exhibition 2011



                                               CONFERENCE REGISTRATION FORM
                                 The preferred method of registration is via the web at www.ausotconference.com.au
 TAX INVOICE                                                                                                                 Date:
 Australian Association of Occupational Therapists Inc. ABN: 27 025 075 008                                                          d/mm/yy
 This form enables you to:                                                      Important Notes
      register to attend the Occupational Therapy Australia 24th                    Note that all prices quoted are in Australian dollars (AUD)
          National Conference & Exhibition 2011                                         and inclusive of Goods and Services Tax (GST)
      indicate attendance and book guests for Conference Social                        except for the accommodation deposit where the GST will
          Events and                                                                    be included in the final balance of accommodation paid on
      book accommodation for the Conference                                            check out
                                                                                     By completing this registration form you have read,
 To complete this form:                                                                 understood and agreed to both the cancellation policies and
 Please move between fields by using the tab key, or if you prefer,                     the privacy statement as stated on this form
 print the form and use block letters. Please keep a copy for your
 records. One form per person please.                                           Please complete and return this form along with payment to:

                                                                                OCCUPATIONAL THERAPY AUSTRALIA 24th National Conference & Exhibition
                                                                                Conference Office - Think Business Events
                                                                                Suite 6, 23 Hoddle Street Richmond VIC 3121
                                                                                Email: ot2011@thinkbusinessevents.com.au
                                                                                Fax: 03 8610 2170
 REGISTRATION DETAILS
 Contact Details
     Mr           Ms           Mrs           Miss            Dr         Prof.      Other (please specify)
 Last Name                                                         First Name

 Organization
 Position
 Address
 Suburb/Town
 State                                                             Country                                         Postcode
 Work Phone            (        )                                  Work Fax        (         )                     Mobile
 Email
 Membership
 To qualify for the Member Rate, you will need to be a member of Occupational Therapy Australia, a division of Occupational Therapy Australia,
 NZAOT, WFOT or International Association that is a member of WFOT or another approved allied health professional association. Your
 membership status will be verified with the relevant association
                                                                                                                                  Membership Number
     Occupational Therapy Australia Member
     Occupational Therapy Australia Division Member                Division
     Approved allied health professional association               Association Name
     WFOT / International Association                              Association Name
     NZAOT New Zealand Association of Occupational Therapists
 Role at Conference
Please indicate what your role at the conference will be.

    Delegate                                             Speaker                                             Committee Member (CPSC/SMT)

    Occupational Therapy Australia 24th National Conference & Exhibition 2011, 29 June – 1 July 2011, Gold Coast Convention & Exhibition Centre.
CONFERENCE REGISTRATION
Registration fee is per person and includes attendance to conference, morning tea, lunch, afternoon tea (no afternoon tea on Friday),
delegate satchel and conference materials.

Please note there are no reduced Early Bird fees for day and student registrations

                                                                                                         Early Bird Rate1                             Standard Rate
Registration Type
                                                                                                         (Up to 13th April)                          (After 13th April)
Full Registration
    OT Member2                                                                                                   AUD $655.00                          AUD $755.00
    Non Member Full Registration                                                                                 AUD $975.00                          AUD $1155.00
    Student3 Member Full Registration                                                                            AUD $445.00                          AUD $445.00
    Student3 Non-Member Full Registration                                                                        AUD $525.00                          AUD $525.00
    New Graduate* Member Registration                                                                            AUD $545.00                          AUD $545.00
Day Registration
Member2 Day Registration                Wednesday                           Thursday          Friday             AUD $375.00                           AUD $375.00
Non Member Day Registration             Wednesday                           Thursday          Friday             AUD $525.00                           AUD $525.00
Student member Registration3
                                        Wednesday                           Thursday          Friday             AUD $250.00                           AUD $250.00
Day Registration
Student Non member Registration3
                                        Wednesday                           Thursday          Friday             AUD $290.00                           AUD $290.00
Day Registration
                                                                                              TOTAL             AUD $                                 AUD $

REGISTRATION CONDITIONS
Cancellation Statement: Cancellations received in writing at the Conference Office by 20th May 2011 will be accepted and all fees refunded less an administrative fee of $100.00.
Cancellations received after this date cannot be accepted and will not be refunded.
Transfer of registration: Transfer of your registration to another person is acceptable. The full name and details of the person that will replace you must be advised in writing to
the Conference Office prior to the Conference.
Non-attendance: No refunds will be made for non-attendance at the Conference.
NOTES
      1.    To qualify for early bird registration, registration fees must be received by 13th April 2011. Registration fees are based on date of payment receipt, not the date of
            receipt of registration form.
      2.    To qualify for the member rate, you will need to be a member of Occupational Therapy Australia, a division of Occupational Therapy Australia, NZAOT, WFOT or
            International association that is a member of WFOT or another approved allied health professional association. Your membership status will be verified with the
            relevant association. Please contact OCCUPATIONAL THERAPY AUSTRALIA at www.ausot.com.au for more information.
Student registrations
      3. Must show valid student ID when arriving to register at the Conference. Students include those studying as full time or post graduates.

Graduate registrations
     *    To qualify for the graduate fee, you must be an OT who has graduated within the last year as per the Occupational Therapy Australia graduate membership guidelines


PRE CONFERENCE WORKSHOP REGISTRATION
The pre Conference workshops will be held on Tuesday 28th June 2011.The venue will be advised closer to the conference.
For further information on the pre conference workshops, please visit the conference website at: http://ausotconference.com.au/pre-
conference-workshops.php

Please indicate your attendance by selecting the appropriate box below.
PRE CONFERENCE WORKSHOP
                                                                    OT Member                    Non Member                   Student Member               Student Non
                                                                                                                                                           Member
Workshop B: (full day)
Using the evidence in working within indigenous
                                                                              AUD$250                      AUD$375                      AUD$135                      AUD$190
and rural communities
Presenters: Jo Jackson King & Barbara King
Workshop C: (full day)
OT assessment and interventions for impairments
                                                                              AUD$250                     AUD$375                       AUD$135                      AUD$190
of visual perception and praxis in adults
Presenter: Deirdre Cook
Workshop D: (full day)
Implementing evidence-based upper extremity
interventions through childhood and adolescence
                                                                              AUD$250                      AUD$375                     AUD$135                       AUD$190
for individuals with cerebral palsy
Presenters: Christine Imms, Brian Hoare, Melinda
Randall, Sue Greaves, Iona Novak

    Occupational Therapy Australia 24th National Conference & Exhibition 2011, 29 June – 1 July 2011, Gold Coast Convention & Exhibition Centre.
Workshop E: (full day)
Building research capacity: skills for qualitative
                                                                  AUD$250                 AUD$375                  AUD$135                  AUD$190
research
Presenter: Mandy Stanley
Workshop F: ( full day)
The Science of Seating, Posture & Pressure Care
for 2011                                                          AUD$250                 AUD$375                 AUD$135                   AUD$190
Presenters: Florence Clark, Jillian Swaine &
Michael Stacey
Workshop I: (full day)
Supporting recovery to work in Mental Health                      AUD$250                 AUD$375                  AUD$135                  AUD$190
Presenter: Bonnie Kirsh
                                               TOTAL        AUD $                    AUD $                   AUD $                    AUD $


EDUCATION DAY REGISTRATION
The Education Day will be held on Tuesday 28th June 2011 from 9 – 4:00pm. The venue will be advised closer to the conference. For further
information, please visit the website at: http://ausotconference.com.au/education-day.php

Please indicate your attendance at the Education Day by selecting the appropriate box below.
                                                                                          Standard Rate
Registration Type
    OT Member                                                                                      AUD $145.00
    Non Member                                                                                     AUD $225.00
    Student 3 Member                                                                               AUD $95.00
    Student 3 Non-Member                                                                           AUD $135.00
                                              TOTAL                                                AUD $


CATEGORY
Please tick the category that best describes your category / ie of interest (up to 3)


     Ageing/Gerontology                                                           Mental Health
    Assistive Technology/Adaptive Equipment                                       Musculoskeletal/Hand Therapy
    Environmental Modifications                                                   Neurology
    Children, Youth & Families                                                    Occupational Science
    Chronic Pain                                                                  Occupational Therapy Education
    Contemporary practice issues                                                  Occupational Therapy Research
    Driving/Community Mobility                                                    Rehabilitation
    Ergonomics/Workplace Health                                                   Rural and Remote Health
    Health Care Reform/ Policy Development                                        Spinal Cord Injury
    Health Promotion                                                              Stress and Stress Disorders
    Indigenous Health                                                             Working with communities/Community development
    Medico-legal                                                                  Cancer/Palliative Care


WELCOME RECEPTION

Refer to the Social section at www.ausotconference.com.au for full details

Welcome Reception
The Welcome Reception is included in the cost of the Conference Registration fee. For catering purposes, please indicate if attending:

                                                          Wednesday, 29th June 2011
                                           5:00 – 6:00pm, Gold Coast Convention & Exhibition Centre
I will be attending:     Yes          No          Maybe (must be confirmed by 1 June 2011)


   Occupational Therapy Australia 24th National Conference & Exhibition 2011, 29 June – 1 July 2011, Gold Coast Convention & Exhibition Centre.
OTA CONFERENCE DINNER
The OTA Conference Dinner is not included in the conference registration fee. Occupational Therapy Australia is partially subsidising the dinner
for delegates. The cost includes 3 course meal, transfers and cruise.

Please indicate if you would like to purchase tickets for yourself.

                                                           Thursday, 30th June 2011
                                           5:45pm – 11pm, McLaren’s Landing at South Stradbroke Island
Tickets
          I would like to purchase a ticket at AUD $25.00 (incl. GST)



ADDITIONAL TICKETS FOR GUESTS
Please indicate if you would like to purchase additional tickets to the social functions to have partners or guests attend.

                                                           Thursday, 30th June 2011
                                           5:45pm – 11pm, McLaren’s Landing at South Stradbroke Island
Tickets
Conference Dinner - I would like to purchase                  tickets at AUD $ 95.00 (incl. GST) = AUD $

Welcome Reception - I would like to purchase                   tickets at AUD $ 45.00 (incl. GST) = AUD $


SOCIAL EVENTS CONDITIONS
Cancellation Statement: Cancellations for social events received in writing at the Conference Office by Friday 20th May 2011 will be accepted and all costs refunded.
Cancellations received after this date cannot be accepted and will not be refunded.



DIETARY REQUIREMENTS
For catering purposes at the conference and/or social events booked, please indicate if you or your guest(s) have special dietary
requirements.

Delegate
     Vegetarian                               Vegan                                   Gluten Free                             Halal
I have an allergy to
Guest (Social Functions)
Name of Guest
     Vegetarian                               Vegan                                   Gluten Free                             Halal
Has an allergy to


   ACCOMMODATION – Hotel Options
                     ACCOMMODATION MUST BE BOOKED DIRECTLY WITH THE VENUES
                                                                                                                    Rate – Room Only
Hotel                              Hotel booking Conditions                    Room Type                           Rates per room per
                                                                                                                   night
Jupiters Hotel & Casino                 Credit card details will be given
                                                                               Superior Room King                      AUD $179.00
Broadbeach Island,                       to hotel as guarantee
                                                                                                                        AUD $179.00
Broadbeach                                                                     Superior Room Twin
(4 minute walk)
                                        Credit card details will be given     Superior Ocean View Room                 AUD $230.00
Sofitel Gold Coast                       to hotel as guarantee                  (one King bed)
81 Surf Pde, Broadbeach                 Full balance of accommodation
                                                                                                                        AUD $210.00
                                                                               Classic River View Room
(5 minute walk)                          needs to be paid on check in.
                                                                               (one king bed)



   Occupational Therapy Australia 24th National Conference & Exhibition 2011, 29 June – 1 July 2011, Gold Coast Convention & Exhibition Centre.
                                     Credit card details will be given    Double Room                          AUD $140.00
Crowne Plaza                          to hotel as guarantee
2807 Gold Coast                      Full balance of accommodation
Highway                               needs to be paid on check in.
Surfers Paradise                     If paying balance with credit card   Twin Room                            AUD $140.00
                                      a 1.5% surcharge is applied
(10 minute walk)


Meriton Apartments                   Credit card details will be given    Studio Apartment                     AUD $80.00
                                      to hotel as guarantee                One Bedroom Apartment                AUD $90.00
                                     Full balance of accommodation
2669 Gold Coast Hwy,                                                       Two Bedroom Apartment                AUD $145.00
                                      needs to be paid on check in.
Broadbeach
(6 minute walk)                                                            Three Bedroom Apartment              AUD $225.00
Mantra Phoenician                    Full balance of accommodation        One Bedroom Apartment                AUD $131.00
                                      needs to be paid on check in.        (one queen bed)
                                     Credit card details will be given
24-26 Queensland
                                      to hotel as guarantee
Avenue,                              To pay balance using a credit
Broadbeach                            card that is not your own , you      Two Bedroom Apartment                AUD $166.00
(6 minute walk)                       must have a letter of                (one queen bed & two
                                      authorisation to charge the card     singles)
                                      including a photo copy of both
                                      sides of credit card
                                     If paying balance with credit card
                                      a 2% surcharge is applied



PAYMENT
All payments must be made in Australian Dollars only and must include the GST component. Charges paid by credit card will appear as
“Think Business Events Pty Ltd” on your credit card statement. Please transfer all sub totals from the sections above and check your
calculations carefully.
Payment Summary
Conference Registration                                                                                                     AUD $
Pre Conference Workshop                                                                                                     AUD $
Education Day                                                                                                               AUD $
Additional Welcome Reception Tickets                                                                                        AUD $
OTA Conference Ticket- Delegate                                                                                             AUD $
OTA Conference Ticket Guest Ticket                                                                                          AUD $
                                                                                                  TOTAL                     AUD $
Method of Payment
All amounts in this brochure are in Australian dollars (AUD$) and include 10% Goods and Services Tax (GST).

    Cheque                      Payable in AUD$ to “Occupational Therapy Australia Ltd”
    Credit Card:                    Visa                   Mastercard           Diners                American Express

Card Holder Name
Card Number                             /         /          /                                           Expiry Date                   /

Signature




   Occupational Therapy Australia 24th National Conference & Exhibition 2011, 29 June – 1 July 2011, Gold Coast Convention & Exhibition Centre.
TERMS and CONDITIONS
All amounts in this brochure are in Australian dollars (AUD$) and include 10% Goods and Services Tax (GST).

Privacy Statement
Occupational Therapy Australia 24th National Conference is bound by and committed to supporting the National Privacy Principles (NPP's) set out in the Privacy Amendment
(Private Sector) Act 2000.
The Conference will collect and store information you provide in this Registration Form for the purposes of enabling us to register your attendance at the Conference, to assist with
administrative and planning purposes and for future planning and development of the Conference and other events, to facilitate
your requirements in relation to the Conference and to allow the compilation and analysis of statistics relevant to the Conference.
The information that you provide in the Registration form and information provided at any other time during the Conference, including without limitation any feedback obtained
during the Conference, will be used by the Conference to offer, provide and continue to improve its Conferences and other services.
The Conference may disclose some of the information that is collected in the Registration Form such as your name, organisation and its location and your
email address (unless you object in writing to us) to Conference sponsors and exhibitors for marketing purposes.

The Conference will not otherwise, without your consent, use or disclose your personal information for any purpose unless it would reasonably
be expected that such purpose is related to the offer, provision and improvement of the Conference or where such purpose is permitted or required by law.

     No, I do not want my details distributed to sponsors

Cancellation Statement
Cancellations received in writing at the Conference Office by Friday 20th May 2011 will be accepted and all fees refunded less an AUD$100 administrative
fee. Cancellations received after this date cannot be accepted and will not be refunded, however transfer of your registration to another person is acceptable.
The full name and details of the person that will replace you must be advised in writing to the Conference Office prior to the Conference. No refunds will be
made for non-attendance at the Conference.
How did you find out about the conference?
      Colleague told me                             Direct email notification                     Journal advertisement                         Received information in the mail

      Newspaper article                             Website search                                 Workplace notice board

Please complete and return this form to:

OTA 24TH National Conference and Exhibition 2011                                Email:     ot2011@thinkbusinessevents.com.au
Conference Office - Think Business Events                                       Ph:        +61 2 8251 0045
Suite 6, 23 Hoddle Street                                                       Fax:       +61 2 8251 0097
Richmond VIC 3121                                                               Website:   www.ausotconference.com.au




    Occupational Therapy Australia 24th National Conference & Exhibition 2011, 29 June – 1 July 2011, Gold Coast Convention & Exhibition Centre.

								
To top