Registration Form for PSRH Biennial Conference 2009

Pacific Women Well into the Future

PSRH Conference 23 – 26 March 2009

Personal Details
Name on Passport:
Name on name tag:
Title:
Position: Dr: Nurse: Midwife: other:
Workplace:
Email Address:
Address for Correspondence:


Country:
Telephone:
Fax:
Special Requirements:
Registration includes lunch, morning and afternoon teas and Conference Dinner.

Registration Fees:
Vocation Australia/NZ Pacific Is.
Doctor $550 $450
Nurse $550 $450
Midwife $550 $450
Other $100 $100
Payment Method
Select Payment Method: Cheque Direct Credit Credit Card