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Workshop registration

Complete credit card authority and registration form

Register now for following workshops:

a) Essentials of skin cancer medicine: Mar/Apr & Jun 2012 ($1,500)

b) September 2012 -  5 day flap and graft workshop ($3,250)

c) Face and ear 3 day reconstruction Nov 2012 workshop ($2,250)

d) Dermoscopy weekends in April & July 2012 ($900)

e) Nurse program in skin cancer management in October 2012 ($300)

Register for more than one event and recieve 10% discount for each.

Registration for all Skincanceronly workshops requires completion and submission of the following on line form. To pay for a workshop by credit card, download this credit card payment authority, complete it and FAX to Skincanceronly at 03 5243 4323 . Note that registration is not confirmed until payment is made in full.

Registration form for all workshops

Complete this registration form and click "submit"

Full name*
Email address*
Street address*
Town / Suburb*
Post code*
State*
Country
Business phone number*
After hours phone number
Business fax number
Division of General Practice - (if applicable)
College affiliation for PDP points - if applicable

PDP number or Date of Birth
I would like to register for the following event. (Select one or more)







Events I have already attended? (Select one or more)



I plan to bring a partner to the workshop dinner. I understand an added cost is involved.*


I intend to pay for the workshop by*



My diet requirements are*




Comments
I consent to Skincanceronly providing my name and contact details to workshop sponsors*

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*Required