Full name (required)

Private email address (required)

Employer (required)

Division
AdministrationAnaesthetic technicianAudiologistBehavioural SpecialistBiomedical EngineerClinical PhysiologistCSSDDental TherapistDietitianHealth Improvement PractitionerITManagerMedical Laboratory WorkerMedical PhysicistMedical Imaging TechnologistMRI/Nuclear MedicineOccupational TherapistOpticianPerfusionistPharmacy WorkerPhlebotomistPhysiotherapistPsychologistPsychotherapistRadiation TherapistRadiology AdministrationScientific OfficerSocial WorkerSonographerSpeech Language TherapistTrades

Location (required)

Have you attended delegate training before? (required)

Days you will be attending? (required)
8th October9th OctoberBoth days

Do you require flights to be booked for you? (required)
YesNo

If required, please state specific requests for flight times – these will not be changed by APEX once booked unless special circumstances arise.

Do you require accommodation to be booked for you for the 8th? (required)
(Please note that accommodation will be booked on a shared room basis. We will cover the cost of the shared accommodation, however, we will not cover the cost of any incidentals incurred in your stay in the room.)
YesNo

Accommodation requirements other than standard?
Please Note: If you prefer a single room, or to arrange your own accommodation, please state this in the box below.
If you prefer a single room, APEX will book a room for you if available. However, you must pay APEX the cost of the room in advance of attending the conference. We will provide you with account details and cost once the room has been confirmed. (APEX will subsequently provide $100 per night towards the cost of the room).

Preference to share with?

Do you have dietary requirements? Please specify.

Additional Comments or Special Requirements?

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