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25-27 February 2015 
Park and Skyline Rooms, Melbourne Olympic Park 
Olympic Boulevard, Melbourne, Victoria, Australia 
www.changechampions.com.au 
Delivering integrated, consumer directed care 
where, when and how it’s needed. 
Preliminary Program 
Respecting Our Loved 
Older One’s Wishes
Respecting Our Loved Older One’s Wishes 
Delivering integrated, consumer directed care where, when and how it’s needed. 
25-27 February 2015 
Park and Skyline Rooms, Melbourne Olympic Park 
Olympic Boulevard, Melbourne, Victoria, Australia 
Aims 
 To showcase leadership in the cross sectoral and discipline delivery of integrated care that is respectful of the expressed needs of our older loved ones. 
 To share service improvement and quality initiatives that enable care to be provided closer to home or at home for older people. 
 To highlight initiatives to improve the patient/client experience and empower our elderly. 
 To inspire delegates by providing a practical forum that facilitates the exchange tips, ideas and challenges. 
Audience 
All professionals, clinicians, executives and managers with a passion for service improvement and care integration for older people including those: 
 Working in hospital avoidance, service improvement, care integration across the broad range of sectors and disciplines eg acute, aged, community/local government, disability, home care, palliative care, primary care, inc. Medicare Local, policy makers, alliance, partnerships, network and service integrators 
 Committed to enhancing the patient/client experience, facilitating consumer directed care and quality improvement more broadly including those focusing on reducing isolation for our elderly through community development initiatives 
 Advocacy, legal professionals, and others committed to seniors rights, the prevention of elder abuse, complaints handling and sorting out the complexities around powers of attorney, guardianships, wills etc. 
If you missed your opportunity to submit an abstract... 
...you are not alone. We have agreed to keep the call for abstracts for oral presentations in concurrent sessions, 1m x 1m poster presentations open until 31 January 2015. We will continue to take applications to run Master Classes on 25 February 2015 until 31 December 2014. Email your submission to info@changechampions.com.au 
*This program is in evolution. Presentations will be added. Some presentation times may be slightly altered. 
We take no responsibility for any errors or omissions. Please check our website regularly for updates. 
Preliminary Program* 
www.changechampions.com.au
PRELIMINARY PROGRAM 
Day 1: Thursday 26 February 2015 
Session 1 Integrated Care: What’s its true value? 
Chair TBA 
09.00-09.10 Welcome and Housekeeping 
09.10-09.40 Opening Address 
Presentation title to be advised 
Prof Chris Brook 
Chief Advisor, Innovation, Safety and Quality; and, 
Health and Medical Commander 
Department of Health Victoria 
09.40-10.10 Presentation title to be advised 
Prof Peter Gonski 
Director, Division of Aged and Extended Care (Southcare) Sutherland Hospital, NSW 
Clinical Stream Director Aged Care and Rehabilitation 
South Eastern Sydney Local Health District, NSW 
10.10- 10.40 How person centred is your organisation? Creating an online national person-centred organ- isational self-assessment resource for community aged care providers 
Dr David Skyes 
General Manager, Learning and Development 
Alzheimer's Australia VIC 
10.40-11.00 Questions to Speakers 
11.00-11.25 Morning Tea 
View Posters and Network with Delegates and Exhibitors 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 1: Thursday 26 February 2015 
Session 2 Integrated Care In Action 
Chair TBA 
11.25-11.55 Presentation title to be advised 
Carolyn Gullery 
General Manager, Planning, Funding & Decision Support Canterbury & West Coast District Health Boards, NZ 
11.55-12.15 Cross Border Advanced Care Planning: A work in progress 
Jacinta Flood 
Aged Services Emergency Team (ASET) 
Albury Wodonga Health, NSW/VIC 
12.15-12.35 Telehealth - Staying Strong 
Helen Tuxworth 
Team Leader RN, Southern NSW ACT 
integratedliving Australia 
12.40-13.00 Questions to Speakers 
13.00-13.50 Lunch at the Buffet 
Meet Someone New and Swap an Idea Challenge! (with prize) 
View Posters and Network with Delegates and Exhibitors 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 1: Thursday 26 February 2015 
Session 3 Integrated Care In the Community 
Chair TBA 
13.50-14.35 The Falls Rapid Response Service: From conception to delivery 
Carol Foster 
Locality Manager, Adults North 
Nottingham Citycare Partnership, England, UK 
14.35-14.55 Enabling the Inclusion of Seniors Through Intergenerational Initiatives and Social Housing 
in the Auburn LGA 
Anita Ceravolo 
Community Development Officer – Age and Disability 
Auburn City Council, NSW 
14.55-15.15 Presentation to be advised 
15.15-15.30 Questions to Speakers 
15.30-15.50 Afternoon Tea 
View Posters and Network with Delegates and Exhibitors 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 1: Thursday 26 February 2015 
Session 4 Respecting Our Loved One’s Wishes 
Chair TBA 
15.50-16.10 Advocacy as a Tool to Assist the Older Person to Have their Needs and Wishes Realised 
Sonia Di Mezza 
Deputy Chief Executive Officer and Manager of the Aged Care Team 
ACT Disability Aged and Carer Advocacy Service (ADACAS) 
16.10-16.30 A Companion Pair (Building confidence through volunteer and pastoral care services to empower clients to live life to the full!) 
Margaret Woods 
Manager, Mission and Volunteers, Clergy and Congregational Care 
Catholic Community Services NSW/ACT 
16.30-16.50 A critical exploration of empowerment and enablement of the older person, and building of an innovative, competent, compassionate home care workforce 
Eesa Witt 
Specialist Dementia Nurse Consultant 
Witt Consulting, NSW 
16.50-17.07 Questions to Speakers 
17.05 Close 
Seminar Dinner 
7.00 for 7.30pm 
Entrée, Main Course, Dessert and Beverages 
Melbourne Olympic Park 
Entertainment by: 
Rod Quantock, Comedian, Intellectual and Real Life Expert on Ageing 
Maya (from top 30 The Voice) and Special Guests 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 2: Friday 27 February 2015 
Session 5 Safe, Quality Care for Our Older People 
Chair TBA 
09.10-09.40 Opening Address 
Presentation title to be advised 
Prof Joseph E Ibrahim 
CRE-Patient Safety, Department of Epidemiology & Preventive Medicine & Prevention Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, VIC Department of Epidemiology & Preventive Medicine, The Alfred Centre, VIC 
Department of Forensic Medicine, Victorian Institute of Forensic Medicine 
09.40-10.25 The Pan-Canadian Home Care Safety Study: Results and Lessons to Take Home 
Prof Régis Blais 
Department of Health Administration and 
Public Health Research Institute, University of Montreal, Canada 
10.25-10.45 The “Better Practice Guide to Complaint Handling in Aged Care Services”: achieving continuous improvements through an effective complaints process 
Therese Stuart 
Director, Industry Education Section 
Aged Care Complaints Branch 
Australian Government Department of Social Services 
10.45-11.00 Questions to Speakers 
11.00-11.25 Morning Tea 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 2: Friday 27 February 2015 
Session 6 Respectful, Dignified End of Life 
Chair TBA 
11.25-11.45 PEPS (Partnership for excellence in palliative support) 
Provision of 24Hr Support and Co-ordination of Palliative Care for Patients, Families, Carers and Health & Social Care Professionals 
Tracy Haddock 
PEPS Manager, Bedfordshire Partnership For Excellence in Palliative Support (PEPS) 
Co-ordination Centre and Local Implementation Manager, Vitrucare End of Life Pilot 
St Johns Hospice, UK 
11.45-12.30 Comparison of two independently completed advance care directives and their impact on substitute decision making 
Helena Cairney 
Advance Care Planning Manager 
Alfred Health, VIC 
12.30-12.45 Questions to Speakers 
12.45-13.05 Cut to the Chase Poster Presentations 
3 minutes per poster presenter to explain what they did, what they achieved and what they learnt 
13.05-13.55 Lunch at the Buffet 
View Posters and Network with Delegates and Exhibitors 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 2: Friday 27 February 2015 
Session 7 Facilitating Older People’s Independence 
Chair TBA 
13.55-14.20 There’s no need to shout!: assistive listening technology in the delivery of home and 
community elder care 
Lucinda Aberdeen 
Lecturer in Sociology 
University of Sunshine Coast, QLD 
14.20– 14.40 Presentation to be advised 
14.40– 14.50 Questions to Speakers 
14.50– 15.10 Afternoon Tea 
Respecting Our Loved Older One’s Wishes
PRELIMINARY PROGRAM 
Day 2: Friday 27 February 2015 
Session 8 Reconciling Seniors Rights and Family Estrangement, Wills, Powers of Attorney, Guardianships and Other Related Nightmares 
Chair TBA 
15.10-15.30 Developing an Evidence Informed Social Work Guideline for Guardianship and 
Administration applications’ 
Siobhan Feely 
Social Worker 
Royal Melbourne Hospital, VIC 
15.30-16.10 Case studies or “what do I do when…Q&A” 
This session is designed to try to tackle some the difficult and stressful interfamilial issues faced by professionals while caring for their older patients. 
Speakers/panel members to be advised 
16.10 Close 
Respecting Our Loved Older One’s Wishes
Delegate #1 Prof/Dr/Mr/Mrs/Ms/Miss: 
Surname: ____________________________________________________________________ 
Given Name: _________________________________________________________________ 
Company/Organisation: _______________________________________________________ 
Position: ______________________________________________________________________ 
Address: ______________________________________________________________________ 
State: _____________________________________Postcode: __________________________ 
Country: ______________________________________________________________________ 
Telephone: ____________________________________________________________________ 
Email: ________________________________________________________________________ 
Special Diet: ______________________________Disability Assistance: _________________ 
Delegate #2 Prof/Dr/Mr/Mrs/Ms/Miss: 
Surname: ____________________________________________________________________ 
Given Name: _________________________________________________________________ 
Company/Organisation: _______________________________________________________ 
Position: ______________________________________________________________________ 
Address: ______________________________________________________________________ 
State: _____________________________________Postcode: __________________________ 
Country: ______________________________________________________________________ 
Telephone: ____________________________________________________________________ 
Email: ________________________________________________________________________ 
Special Diet: ______________________________Disability Assistance: _________________ 
Delegate #3 Prof/Dr/Mr/Mrs/Ms/Miss: 
Surname: ____________________________________________________________________ 
Given Name: _________________________________________________________________ 
Company/Organisation: _______________________________________________________ 
Position: ______________________________________________________________________ 
Address: ______________________________________________________________________ 
State: _____________________________________Postcode: __________________________ 
Country: ______________________________________________________________________ 
Telephone: ____________________________________________________________________ 
Email: ________________________________________________________________________ 
Special Diet: ______________________________Disability Assistance: _________________ 
REGISTRATION FORM 
Respecting Our Loved Older One’s Wishes 
Park and Skyline Rooms, Melbourne Olympic Park 
Olympic Boulevard, Melbourne, Victoria, Australia 
P. 1 of 3
P. 2 of 3 
SEMINAR PRICING (all prices in AUD inc. GST) 
TWO DAY REGISTRATIONS 
2 Day Registrations for 26 & 27 February 2015– including dinner 
Early bird: Two full days including dinner registered before 13 Feb 2015 ___ x $715 
Standard: Two full days including dinner registered after 13 Feb 2015 ___ x $755 
2 Day Registrations for 26 & 27 February 2015 
Early Bird: Two full days of seminar registered before 13 Feb 2015 ___ x $585 
Standard: Two full days of seminar registered after 13 Feb 2015 ___ x $625 
ONE DAY REGISTRATIONS 
1 Day Registration for 26th February 2015 only 
Early Bird: One day registration for 26th Feb registered before 13 Feb 2015 ___ x $295 
Standard: One day registration for 27th Feb registered after 13 Feb 2015 ___ x $330 
1 Day Registration for 27th February 2015 only 
Early Bird: One day registration for 26th Feb registered before 13 Feb 2015 ___ x $295 
Standard: One day registration for 27th Feb registered after 13 Feb 2015 ___ x $330 
SEPARATE SESSION REGISTRATIONS 
Registration per Session (you must nominate below which Session or Sessions you are attending) ___ x $99 
_____________________________________________________________________________________________________________________________________________________________ 
SPECIAL DISCOUNTED REGISTRATIONS 
2 Day Registration for carers or students 
(You must provide proof of status on entry. Offer does not include any workshops or dinner) 
Early Bird: Two full days of seminar registered before 13 Feb 2015 ___ x $250 
Standard: Two full days of seminar registered before 13 Feb 2015 ___ x $275 
Complimentary Registration 
Complimentary registration for ONE ONLY presenter of an accepted abstract 
(Offer does not include dinner or workshops) ___ x $0 
EXTRAS 
Dinner tickets ___ x $135 
TOTAL AMOUNT PAYABLE $ __________________ (AUD inc. GST) 
All registrations must be paid prior to the seminar. 
Want to avoid the paperwork? Register ONLINE instead! www.changechampions.com.au
P. 3 of 3 
PAYMENT METHODS 
Charmaine Weeks T/A Change Champions & Associates ABN 49 833 110 992 
1. PREFERRED Register ONLINE (avoid the paperwork!!!) at http://www.changechampions.com.au 
Simply visit http://www.changechampions.com.au and scroll down the home page to the seminar of your choice and click on REGISTER. It’s easy. When you register online, you can select your preferred payment option of: 
A) Generate an invoice that will be instantly emailed to the nominated responsible person 
B) Pay by EFT or cheque 
C) Pay online with a credit card 
2. Pay on your Credit Card & email your registration form (3 pages) 
Card No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 digit CVC code: _ _ _ 
Expiry Date: _ _ / _ _ Cardholders Name (PLEASE PRINT)_____________________________________________________ 
Amount : $ __________________ Cardholder's Signature: ____________________________ Date: _ _ /_ _/ _ _ 
3. Pay by cheque/money order 
Please make cheques/money orders for your registration fees only payable to Charmaine Weeks 
4. EFTPOS 
Account name: Charmaine Weeks 
Bank: Westpac 
BSB: 032 569 Account No: 196 411 
Ref No: Respecting (+ your surname) 
5. Request an invoice (All invoices must be paid prior to the workshop) 
Name & position title of person responsible for payment : _____________________________________________________________ 
____________________________________________________________________________________________________________________ 
Email address:____________________________________________________________________Ph:________________________________ 
MAIL: Charmaine Weeks 
P.O. Box 302, Kew, Victoria 3101 AUSTRALIA 
info@changechampions.com.au 
Your registration will be confirmed by email. 
_________________________________________________________________________________________________________________________________________________________________________________ 
*CONDITIONS APPLY 
You must pay on a credit card at the time you register if claiming an online registration discount. 
Conditions & Delegate Cancellation Policy 
A 50% refund will be offered for cancellations received up to 28 days prior to the seminar. No refunds will be given between 0-27 days prior to the seminar but replacement delegate names are accepted. If you have an unpaid invoice as at the first day of an event and for any reason do not attend, we will pursue payment as we will have already incurred costs on your behalf. Applications for cancellations and substitutions of delegates are only accepted in writing by email to 
info@changechampions.com.au. The cancellation policy also appears at http://www.changechampions.com.au at the bottom of the home page under terms and conditions. All registrations must be paid prior to the seminar. 
I have read and understand the conditions and delegate cancellation policy. (Sign below) 
____________________________________signed _____/___/_____ date

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Respecting Our Loved Older One's Wishes Conference

  • 1. 25-27 February 2015 Park and Skyline Rooms, Melbourne Olympic Park Olympic Boulevard, Melbourne, Victoria, Australia www.changechampions.com.au Delivering integrated, consumer directed care where, when and how it’s needed. Preliminary Program Respecting Our Loved Older One’s Wishes
  • 2. Respecting Our Loved Older One’s Wishes Delivering integrated, consumer directed care where, when and how it’s needed. 25-27 February 2015 Park and Skyline Rooms, Melbourne Olympic Park Olympic Boulevard, Melbourne, Victoria, Australia Aims  To showcase leadership in the cross sectoral and discipline delivery of integrated care that is respectful of the expressed needs of our older loved ones.  To share service improvement and quality initiatives that enable care to be provided closer to home or at home for older people.  To highlight initiatives to improve the patient/client experience and empower our elderly.  To inspire delegates by providing a practical forum that facilitates the exchange tips, ideas and challenges. Audience All professionals, clinicians, executives and managers with a passion for service improvement and care integration for older people including those:  Working in hospital avoidance, service improvement, care integration across the broad range of sectors and disciplines eg acute, aged, community/local government, disability, home care, palliative care, primary care, inc. Medicare Local, policy makers, alliance, partnerships, network and service integrators  Committed to enhancing the patient/client experience, facilitating consumer directed care and quality improvement more broadly including those focusing on reducing isolation for our elderly through community development initiatives  Advocacy, legal professionals, and others committed to seniors rights, the prevention of elder abuse, complaints handling and sorting out the complexities around powers of attorney, guardianships, wills etc. If you missed your opportunity to submit an abstract... ...you are not alone. We have agreed to keep the call for abstracts for oral presentations in concurrent sessions, 1m x 1m poster presentations open until 31 January 2015. We will continue to take applications to run Master Classes on 25 February 2015 until 31 December 2014. Email your submission to info@changechampions.com.au *This program is in evolution. Presentations will be added. Some presentation times may be slightly altered. We take no responsibility for any errors or omissions. Please check our website regularly for updates. Preliminary Program* www.changechampions.com.au
  • 3. PRELIMINARY PROGRAM Day 1: Thursday 26 February 2015 Session 1 Integrated Care: What’s its true value? Chair TBA 09.00-09.10 Welcome and Housekeeping 09.10-09.40 Opening Address Presentation title to be advised Prof Chris Brook Chief Advisor, Innovation, Safety and Quality; and, Health and Medical Commander Department of Health Victoria 09.40-10.10 Presentation title to be advised Prof Peter Gonski Director, Division of Aged and Extended Care (Southcare) Sutherland Hospital, NSW Clinical Stream Director Aged Care and Rehabilitation South Eastern Sydney Local Health District, NSW 10.10- 10.40 How person centred is your organisation? Creating an online national person-centred organ- isational self-assessment resource for community aged care providers Dr David Skyes General Manager, Learning and Development Alzheimer's Australia VIC 10.40-11.00 Questions to Speakers 11.00-11.25 Morning Tea View Posters and Network with Delegates and Exhibitors Respecting Our Loved Older One’s Wishes
  • 4. PRELIMINARY PROGRAM Day 1: Thursday 26 February 2015 Session 2 Integrated Care In Action Chair TBA 11.25-11.55 Presentation title to be advised Carolyn Gullery General Manager, Planning, Funding & Decision Support Canterbury & West Coast District Health Boards, NZ 11.55-12.15 Cross Border Advanced Care Planning: A work in progress Jacinta Flood Aged Services Emergency Team (ASET) Albury Wodonga Health, NSW/VIC 12.15-12.35 Telehealth - Staying Strong Helen Tuxworth Team Leader RN, Southern NSW ACT integratedliving Australia 12.40-13.00 Questions to Speakers 13.00-13.50 Lunch at the Buffet Meet Someone New and Swap an Idea Challenge! (with prize) View Posters and Network with Delegates and Exhibitors Respecting Our Loved Older One’s Wishes
  • 5. PRELIMINARY PROGRAM Day 1: Thursday 26 February 2015 Session 3 Integrated Care In the Community Chair TBA 13.50-14.35 The Falls Rapid Response Service: From conception to delivery Carol Foster Locality Manager, Adults North Nottingham Citycare Partnership, England, UK 14.35-14.55 Enabling the Inclusion of Seniors Through Intergenerational Initiatives and Social Housing in the Auburn LGA Anita Ceravolo Community Development Officer – Age and Disability Auburn City Council, NSW 14.55-15.15 Presentation to be advised 15.15-15.30 Questions to Speakers 15.30-15.50 Afternoon Tea View Posters and Network with Delegates and Exhibitors Respecting Our Loved Older One’s Wishes
  • 6. PRELIMINARY PROGRAM Day 1: Thursday 26 February 2015 Session 4 Respecting Our Loved One’s Wishes Chair TBA 15.50-16.10 Advocacy as a Tool to Assist the Older Person to Have their Needs and Wishes Realised Sonia Di Mezza Deputy Chief Executive Officer and Manager of the Aged Care Team ACT Disability Aged and Carer Advocacy Service (ADACAS) 16.10-16.30 A Companion Pair (Building confidence through volunteer and pastoral care services to empower clients to live life to the full!) Margaret Woods Manager, Mission and Volunteers, Clergy and Congregational Care Catholic Community Services NSW/ACT 16.30-16.50 A critical exploration of empowerment and enablement of the older person, and building of an innovative, competent, compassionate home care workforce Eesa Witt Specialist Dementia Nurse Consultant Witt Consulting, NSW 16.50-17.07 Questions to Speakers 17.05 Close Seminar Dinner 7.00 for 7.30pm Entrée, Main Course, Dessert and Beverages Melbourne Olympic Park Entertainment by: Rod Quantock, Comedian, Intellectual and Real Life Expert on Ageing Maya (from top 30 The Voice) and Special Guests Respecting Our Loved Older One’s Wishes
  • 7. PRELIMINARY PROGRAM Day 2: Friday 27 February 2015 Session 5 Safe, Quality Care for Our Older People Chair TBA 09.10-09.40 Opening Address Presentation title to be advised Prof Joseph E Ibrahim CRE-Patient Safety, Department of Epidemiology & Preventive Medicine & Prevention Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, VIC Department of Epidemiology & Preventive Medicine, The Alfred Centre, VIC Department of Forensic Medicine, Victorian Institute of Forensic Medicine 09.40-10.25 The Pan-Canadian Home Care Safety Study: Results and Lessons to Take Home Prof Régis Blais Department of Health Administration and Public Health Research Institute, University of Montreal, Canada 10.25-10.45 The “Better Practice Guide to Complaint Handling in Aged Care Services”: achieving continuous improvements through an effective complaints process Therese Stuart Director, Industry Education Section Aged Care Complaints Branch Australian Government Department of Social Services 10.45-11.00 Questions to Speakers 11.00-11.25 Morning Tea Respecting Our Loved Older One’s Wishes
  • 8. PRELIMINARY PROGRAM Day 2: Friday 27 February 2015 Session 6 Respectful, Dignified End of Life Chair TBA 11.25-11.45 PEPS (Partnership for excellence in palliative support) Provision of 24Hr Support and Co-ordination of Palliative Care for Patients, Families, Carers and Health & Social Care Professionals Tracy Haddock PEPS Manager, Bedfordshire Partnership For Excellence in Palliative Support (PEPS) Co-ordination Centre and Local Implementation Manager, Vitrucare End of Life Pilot St Johns Hospice, UK 11.45-12.30 Comparison of two independently completed advance care directives and their impact on substitute decision making Helena Cairney Advance Care Planning Manager Alfred Health, VIC 12.30-12.45 Questions to Speakers 12.45-13.05 Cut to the Chase Poster Presentations 3 minutes per poster presenter to explain what they did, what they achieved and what they learnt 13.05-13.55 Lunch at the Buffet View Posters and Network with Delegates and Exhibitors Respecting Our Loved Older One’s Wishes
  • 9. PRELIMINARY PROGRAM Day 2: Friday 27 February 2015 Session 7 Facilitating Older People’s Independence Chair TBA 13.55-14.20 There’s no need to shout!: assistive listening technology in the delivery of home and community elder care Lucinda Aberdeen Lecturer in Sociology University of Sunshine Coast, QLD 14.20– 14.40 Presentation to be advised 14.40– 14.50 Questions to Speakers 14.50– 15.10 Afternoon Tea Respecting Our Loved Older One’s Wishes
  • 10. PRELIMINARY PROGRAM Day 2: Friday 27 February 2015 Session 8 Reconciling Seniors Rights and Family Estrangement, Wills, Powers of Attorney, Guardianships and Other Related Nightmares Chair TBA 15.10-15.30 Developing an Evidence Informed Social Work Guideline for Guardianship and Administration applications’ Siobhan Feely Social Worker Royal Melbourne Hospital, VIC 15.30-16.10 Case studies or “what do I do when…Q&A” This session is designed to try to tackle some the difficult and stressful interfamilial issues faced by professionals while caring for their older patients. Speakers/panel members to be advised 16.10 Close Respecting Our Loved Older One’s Wishes
  • 11. Delegate #1 Prof/Dr/Mr/Mrs/Ms/Miss: Surname: ____________________________________________________________________ Given Name: _________________________________________________________________ Company/Organisation: _______________________________________________________ Position: ______________________________________________________________________ Address: ______________________________________________________________________ State: _____________________________________Postcode: __________________________ Country: ______________________________________________________________________ Telephone: ____________________________________________________________________ Email: ________________________________________________________________________ Special Diet: ______________________________Disability Assistance: _________________ Delegate #2 Prof/Dr/Mr/Mrs/Ms/Miss: Surname: ____________________________________________________________________ Given Name: _________________________________________________________________ Company/Organisation: _______________________________________________________ Position: ______________________________________________________________________ Address: ______________________________________________________________________ State: _____________________________________Postcode: __________________________ Country: ______________________________________________________________________ Telephone: ____________________________________________________________________ Email: ________________________________________________________________________ Special Diet: ______________________________Disability Assistance: _________________ Delegate #3 Prof/Dr/Mr/Mrs/Ms/Miss: Surname: ____________________________________________________________________ Given Name: _________________________________________________________________ Company/Organisation: _______________________________________________________ Position: ______________________________________________________________________ Address: ______________________________________________________________________ State: _____________________________________Postcode: __________________________ Country: ______________________________________________________________________ Telephone: ____________________________________________________________________ Email: ________________________________________________________________________ Special Diet: ______________________________Disability Assistance: _________________ REGISTRATION FORM Respecting Our Loved Older One’s Wishes Park and Skyline Rooms, Melbourne Olympic Park Olympic Boulevard, Melbourne, Victoria, Australia P. 1 of 3
  • 12. P. 2 of 3 SEMINAR PRICING (all prices in AUD inc. GST) TWO DAY REGISTRATIONS 2 Day Registrations for 26 & 27 February 2015– including dinner Early bird: Two full days including dinner registered before 13 Feb 2015 ___ x $715 Standard: Two full days including dinner registered after 13 Feb 2015 ___ x $755 2 Day Registrations for 26 & 27 February 2015 Early Bird: Two full days of seminar registered before 13 Feb 2015 ___ x $585 Standard: Two full days of seminar registered after 13 Feb 2015 ___ x $625 ONE DAY REGISTRATIONS 1 Day Registration for 26th February 2015 only Early Bird: One day registration for 26th Feb registered before 13 Feb 2015 ___ x $295 Standard: One day registration for 27th Feb registered after 13 Feb 2015 ___ x $330 1 Day Registration for 27th February 2015 only Early Bird: One day registration for 26th Feb registered before 13 Feb 2015 ___ x $295 Standard: One day registration for 27th Feb registered after 13 Feb 2015 ___ x $330 SEPARATE SESSION REGISTRATIONS Registration per Session (you must nominate below which Session or Sessions you are attending) ___ x $99 _____________________________________________________________________________________________________________________________________________________________ SPECIAL DISCOUNTED REGISTRATIONS 2 Day Registration for carers or students (You must provide proof of status on entry. Offer does not include any workshops or dinner) Early Bird: Two full days of seminar registered before 13 Feb 2015 ___ x $250 Standard: Two full days of seminar registered before 13 Feb 2015 ___ x $275 Complimentary Registration Complimentary registration for ONE ONLY presenter of an accepted abstract (Offer does not include dinner or workshops) ___ x $0 EXTRAS Dinner tickets ___ x $135 TOTAL AMOUNT PAYABLE $ __________________ (AUD inc. GST) All registrations must be paid prior to the seminar. Want to avoid the paperwork? Register ONLINE instead! www.changechampions.com.au
  • 13. P. 3 of 3 PAYMENT METHODS Charmaine Weeks T/A Change Champions & Associates ABN 49 833 110 992 1. PREFERRED Register ONLINE (avoid the paperwork!!!) at http://www.changechampions.com.au Simply visit http://www.changechampions.com.au and scroll down the home page to the seminar of your choice and click on REGISTER. It’s easy. When you register online, you can select your preferred payment option of: A) Generate an invoice that will be instantly emailed to the nominated responsible person B) Pay by EFT or cheque C) Pay online with a credit card 2. Pay on your Credit Card & email your registration form (3 pages) Card No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 digit CVC code: _ _ _ Expiry Date: _ _ / _ _ Cardholders Name (PLEASE PRINT)_____________________________________________________ Amount : $ __________________ Cardholder's Signature: ____________________________ Date: _ _ /_ _/ _ _ 3. Pay by cheque/money order Please make cheques/money orders for your registration fees only payable to Charmaine Weeks 4. EFTPOS Account name: Charmaine Weeks Bank: Westpac BSB: 032 569 Account No: 196 411 Ref No: Respecting (+ your surname) 5. Request an invoice (All invoices must be paid prior to the workshop) Name & position title of person responsible for payment : _____________________________________________________________ ____________________________________________________________________________________________________________________ Email address:____________________________________________________________________Ph:________________________________ MAIL: Charmaine Weeks P.O. Box 302, Kew, Victoria 3101 AUSTRALIA info@changechampions.com.au Your registration will be confirmed by email. _________________________________________________________________________________________________________________________________________________________________________________ *CONDITIONS APPLY You must pay on a credit card at the time you register if claiming an online registration discount. Conditions & Delegate Cancellation Policy A 50% refund will be offered for cancellations received up to 28 days prior to the seminar. No refunds will be given between 0-27 days prior to the seminar but replacement delegate names are accepted. If you have an unpaid invoice as at the first day of an event and for any reason do not attend, we will pursue payment as we will have already incurred costs on your behalf. Applications for cancellations and substitutions of delegates are only accepted in writing by email to info@changechampions.com.au. The cancellation policy also appears at http://www.changechampions.com.au at the bottom of the home page under terms and conditions. All registrations must be paid prior to the seminar. I have read and understand the conditions and delegate cancellation policy. (Sign below) ____________________________________signed _____/___/_____ date