ConPharm 2022 registration form

Contact details

Hidden

Unique ID

MRN

Name (will appear on certificate)*

Title First Last

Badge name (will appear on badge)*

First Last

Postal address*

Street Address Address Line 2 Suburb State Postcode

Mobile*

Email*

Registration options

I agree to have my Name and State printed on a list made available to all attendees*

Yes
No

Is this your first time attending the ConPharm Seminar?*

Yes
No

Conference registration

Registration Details*

Seminar Registration Friday 17 June 9:30am - Sunday 19 June 12:30pm - $695*

Welcome reception - Friday 17 June 6:30pm - 9:30pm*

For catering purposes please select all that apply. Please contact us for more options.

NOT attending
Attending (registrant) - no extra charge
1 additional adult - $50
1 additional child - $30
2 additional children - $60

Welcome reception - additional nametags

Please enter the names of any additional adults or children over three attending the Welcome reception

Special dietary requirements

Total

$ 0.00

Payment method*

Electronic transfer to AACP
Credit card via AACP website
Cheque
Invoice prior to payment
Payment plan

Terms and conditions*

I have read the terms and conditions

Confirmation of registration form will be acknowledged via email by next working day. If you do not receive confirmation from the ConPharm organisers please give the office a call on 02 6120 2800 (Option 6). All prices are GST inclusive. A tax receipt will be issued after payment is received.