ADAVB CONVENTION 10-11 August 2018
Victorian Dental Show by
MELBOURNE CONVENTION & EXHIBITION CENTRE
• 4 International Keynote Speakers • 4 Conference Programs and Sessions • Over 30 Speakers • Over 40 topics • Dentists Program • Practice Managers Program • Dental Assistants Program • Dental Hygienists and Dental & Oral Health Therapists Program
12 CPD Hours
Website • convention.adavb.org
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Early Bird Registrations Now Open
2018 ADAVB Convention – Friday 10 & Saturday 11 August REGISTRATION FORM AND TAX INVOICE Complete the form below or register online : registration.convention.adavb.org NOTE: One registration form per delegate. Please register online for multiple delegates or make copies of this form. 1. Dentist 2. Dentist Specialist 3. Dentistry Student/Retired 4. Dental & Oral Health Therapist 5. Hygienist 6. Dental & Oral Health Therapist Student 7. Hygienist Student 8. Dental Assistant 9. Practice Manager ADAVB or ADA Interstate Membership No Title
Non Member
First name
Mobile
Your Profession _______ (e.g 1, 2 or 3)
Surname Email
Dietary requirement(s) (Your confirmation and reminder will be sent to this email)
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CATEGORIES
Early Bird Rate
Full Rates
(Ending 31 May)
(As of 1 June)
Quantity
Amount
Dentists Program – Friday 10 & Saturday 11 August ADAVB Member
$790
$950
Non-ADAVB Member
$1200
$1775
Recent Graduate Member* (1st - 5th year)
$380
$475
Recent Graduate Non-Member* (1st - 5th year)
$580
$675
Dentistry Student*/Retired
$145
$200
Dentists Program Day 1 – Friday 10 August OR
$415
$525
Non-ADAVB Member
$620
$620
Recent Graduate Member* (1st - 5th year)
$190
$238
Recent Graduate Non-Member* (1st - 5th year)
$290
$290
Dentistry Student*/Retired
$75
$100
Practice Managers Program – 10 August
$350
$400
Dental Assistant Program –11 August
$150
$220
Dental Hygienists and Dental & Oral Health Therapists Program – 11 August
$260
$320
Student Dental Hygienists and Dental & Oral Health Therapists
QUERIES: cpd@adavb.org Phone: (03) 8825 4600
• Prices quoted are per person in Australian dollars, inclusive of Goods and Services Tax (GST). • By completing this form, delegates are automatically registered for the ADIA Exhibition and as such your details will be made available to ADIA. • *Registration includes Cocktail Party on Saturday 11 August 7.30pm • If you do not wish for ADIA to disclose your details to the exhibitors on the delegate list, tick here
$95
eviDent Fundraiser Dinner (Single ticket)
$140
$160
eviDent Fundraiser Dinner (Table of 10)
$1300
$1500 TOTAL PAYMENT
Fax: (03) 8825 4644 Post: PO BOX 9015 South Yarra VIC 3141
Day 2 - Saturday 11 August
ADAVB Member
SEND COMPLETED FORMS TO: cpd@adavb.org
$
PAYMENT DETAILS Card type:
Cheque (made payable to ADAVB Inc)
Visa
Mastercard
Card number
American Express (Diners Club Not Accepted)
Expiry date
I,
/
(name on card) hereby authorise ADAVB to debit my credit card.
Total amount
$
Cardholder's 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.