oral supporting the cancer patient with their
registration form 10 NOV 2014
|
8:30AM TO 4:30PM
An attendance certificate will be issued and 6 CPD points identified.
health care
Queensland Health Staff
External to Queensland Health
No Cost
$220 per participant
ATTENDANCE TYPE: Face to Face Venue
OR
Conference Rooms 2 and 3 Skills Development Centre Royal Brisbane and Women’s Hospital
Catering Morning tea, lunch and afternoon tea will be provided.
Videoconference ** You must book a room with videoconference equipment before registering ** The 4-digit code will be emailed to you 1 week prior to the workshop
Special Dietary Requirements If you have significant allergies, please provide your own food as dietary requirements cannot be guaranteed.
TITLE:
SURNAME:
FIRST NAME:
PREFERRED BADGE NAME: POSITION:
PAYROLL NO: (DoH only) Specify grade/position/stream here:
HOSPITAL/DIVISION:
HHS:
PHONE:
MOBILE:
EMAIL: ATTENDEE’S NAME:
SIGNATURE: DATE:
(Applies ONLY to Queensland Health staff) SUPERVISOR’S NAME: (if applicable)
SIGNATURE:
POSITION:
DATE:
BILLING ADDRESS (Applies ONLY to those External to Queensland Health) Name invoice made out to:
ABN:
Postal address: Contact for invoice:
Please complete the above and forward to: Email: Phone:
CIRCS@health.qld.gov.au (preferred method) Paul Ng – (07) 3131 1690
Fax:
(07) 3131 1513
Central Integrated Regional Cancer Service