Dementia + Recreation Conference registration form, Melbourne, August 2014 v2
Please PRINT clearly & ensure form is fully completed
Surname: First name:
Phone No: ( )
Email (REQUIRED PLEASE):
Position (eg - Activities Co-ordinator, Lifestyle Officer):
Attendance for: Both Days Day One only Day Two only
Registration type: Full Registration Full Time Undergraduate Student
Are you willing for your name & details to be included on a list distributed to the Trade Displayers? Yes No
Any specific dietary needs? (eg. Gluten free, not personal preferences). If so, please specify:
Both days Full Registration $660 Full Time Undergraduate Student $330
Single day Full Registration $330 Full Time Undergraduate Student $165
All Registration fees include GST and provide full catering,
access to the Trade Expo and a copy of the Conference presentations.
(1) For all full 2 day registrations (up to a limit) received paid for by Friday June 6 2014, a colleague or second
delegate can attend for free (2 for 1 offer).
(2) The first fifty (50) full 2 day registrations received fully paid for after the 2 for 1 discount concludes, will receive
a $50 voucher to spend with the Trade Displayer of their choice at the conference’s Trade Expo.
This Registration Form together with payment to be sent to: Wayne Woff - Manager, Total Aged Services,
99 Kambrook Road, Caulfield North VIC 3161 or faxed to 03 9571 9708 or emailed to email@example.com
by no later than Thursday August 14 2014
Cheques or Money Orders to be made payable to: Total Aged Services. CREDIT CARD PAYMENT NOT AVAILABLE.
For Direct Debit details contact our office on 03 9571 5606 or firstname.lastname@example.org
This document will be a tax invoice for GST purposes when you make a payment
(Total Aged Services ABN: 86 775 168 953)
2 for 1
EARLY BIRD SPECIAL
This Conference is recognised by Diversional
Therapy Australia - eligible participants will
earn 10 DTA Professional Development Points
for attendance. The conference also qualifies
for 10 CPD hours under the AHPRA requirements
for relevant health professionals.
Facilities Management in Aged Care Conference