Dental Hygienists and Dental & Oral Health Therapists Program Joint
Saturday 18 June 2016 Melbourne Convention and Exhibition Centre
Register NOW
6 CPD HOURS
An exciting program jointly developed by the member associations for dental hygienists and dental & oral health therapists in conjunction with ADAVB. With an outstanding cast of presenters, the program is packed with topics you must know or interested to know more about. Come along to learn,
Fissure sealants - an opportunity for minimum intervention Exploring opportunities - leadership and teamwork in the dental profession Integrated patient care - working with allied health practitioners
Speakers
Topics
network and attend the Victorian Dental Show! Professor Ian Meyers Associate Professor Nicky Kilpatrick Dr Warren Shnider Professor Michael McCullough Ms Amanda Brown
What’s that?! An opportunity to revisit
Associate Professor Phillippe Zimet
common oral pathology
Dr Terry Wong
Being the best - comprehensive infection control practice
This exciting and stimulating program is a collaboration with
Dental trauma - it all happened so quickly Opportunities for success. Creating a beautiful restoration for a fractured incisor
2016 ADAVB Convention
Your registration will include FREE ENTRY to the Victorian Dental Show by
To attend the Dental Show only, you must register at adia.org.au
http://convention.adavb.org
Proudly supported by
2016 ADAVB Convention - Saturday 18 June REGISTRATION FORM AND TAX INVOICE PRIMARY REGISTRATION Professions:
1. Dental & Oral Health Therapist
Title
2. Hygienist
3. Student
First name
Member
Non Member
Surname Your Profession _______ (e.g 1, 2 or 3)
Address Suburb
State
Phone
Postcode
Country
Mobile
Special dietary requirement(s) (Important: Your confirmation and reminder will be sent to this email)
SECONDARY APPLICANT (If more than one additional, please make a copy of this registration form and include names.)
Title
First name
Surname
Your Profession ______ (e.g 1, 2 or 3) Special dietary requirement(s)
(Important: Your confirmation and reminder will be sent to this email)
Address
(if different to primary registrants address above)
CATEGORIES
Rates
Quantity
Amount
Member Dental Hygienists and Dental & Oral Health Therapists (18 June)
$550
$
Non-Member Dental Hygienists and Dental & Oral Health Therapists (18 June)
$750
$
Student (18 June)
$95
$ $
TOTAL PAYMENT REGISTER TO: Email: cpd@adavb.org Fax: (03) 8825 4644 Post: PO Box 9015 South Yarra VIC 3141
• Prices quoted are per person in Australian dollars, inclusive of Goods and Services Tax (GST). • Full-time students must attach proof of their status (e.g. photocopy of student ID) • By completing this form, delegates are automatically registered for the ADIA Exhibition (Saturday 18 June) and as such your details will be made available to ADIA.
QUERIES: Email: cpd@adavb.org
• If you do not wish for ADIA to disclose your details to the exhibitors on the delegate list, tick here
Phone: (03) 8825 4600
PAYMENT DETAILS Cheque (made payable to ADAVB Inc)
Card type:
Visa
Card number
American Express (Diner Club Not Accepted) Expiry date
I, Total amount
MasterCard
/
(name on card) hereby authorise ADAVB to debit my credit card.
$
Cardholder signature
FULL PAYMENT MUST ACCOMPANY YOUR REGISTRATION, SEND TO: Australian Dental Association Victorian Branch – Level 3, 10 Yarra Street, South Yarra 3141 / PO BOX 9015, South Yarra 3141 or fax (03) 8825 4644. By completing this registration form, you have read and understood all the terms and conditions (see http://convention.adavb.org for information) stipulated herein and agree to both the cancellation policy and privacy statement. Make a copy of this registration form and maintain it for your records. ADAVB ABN 80 263 088 594, ARBN 152 948 680 & Reg’d Assoc No. A0022649E.