Section 1

Title

First Name

Family Name

Badge Name

(only if different from above) 

Job Title 

Division  

Organisation

Address Line 1

Address Line 2

Suburb/City 

State

    Postal Code 

Country 

NonePlease SelectAfghanistanAlaskaAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Antarctic TerritoryBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'Ivoire (Ivory Coast)Croatia (Hrvatska)CubaCyprusCzech RepublicDemocratic Republic of CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench Austral and Antarctic TerritoriesFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGalapagosGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHawaiiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (North)Korea (South)KuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern IrelandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPlease SelectPolandPortugalPuerto RicoQatarReunionRomaniaRoss DependencyRussian FederationRwandaS. Georgia and S. Sandwich IslsSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Kitts and NevisSt. Pierre and MiquelonSt. Vincent and the GrenadinesSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUS Minor Outlying IslandsUzbekistanVanuatuVaticanVenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wake IslandWalesWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZaireZambiaZimbabwe   (Required)

Business Phone

Business Fax

Mobile Phone 

E-Mail Address  

please ensure address is spelt correctly

Is this your Work Address?

Special Dietary Requirements

Other Requirements   

wheelchair access etc

Send Correspondence

E-Mail

Fax    

 Mail 

Note:

If you disagree with either of the above statements please click on the appropriate tick box and remove the 'tick".

Accompanying Person Information 

You only need to complete this section if you will be purchasing extra function tickets or sharing a room with your non delegate partner.

Title    

First Name

Surname 

Badge Name

(only if different from above) 

Special Diet Requirements  

Full Registration includes:

Attendance to all conference sessions, Ticket to Welcome Reception, Free pass to Mind to Care Art Exhibition (Attend anytime, repeat visits ok), Oration, access to exhibition area, conference satchel with complete conference program, morning and afternoon Teas DAILY and lunches DAILY.

The welcome reception and oration are included in the full registration fee for members, non members, consumers and carers. It is not included in student or day delegate registration fees.

All delegates receive a free pass to the Mind to Care Art Exhibition.

The Three Day registration package covers the International Conference Program on Mental Health Nursing from Wednesday 30th September to Friday 2nd October (Day 2 through to Day 4).

The Four Day registration package includes additional attendance at a discounted rate to the pre-conference workshops or symposium preceding day on Tuesday 29th September, as selected.

Tickets to attend the conference dinner can be purchased in section 4, you may also purchase extra tickets to the Welcome Function in section 4.

Members of the American Psychiatric Nurses Association (APNA) are eligible to register for the College membership rate by reciprocal arrangement between the ACMHN and APNA.

If you are registering as a member of the College or APNA please select the organisation you belong to:  ACMHN       or APNA 

Full Registration  

None Selected Member 3 day Non Member 3 day Member 4 day Non Member 4 day Undergraduate or Student 3 day Undergraduate or Student 4 day Consumer or Carer 3 day Consumer or Carer 4 day Exhibitor Staff Registration

The welcome reception is included in the full registration fee. It is not included in student or day delegate registration fees. Please indicate whether you will or will not attend the welcome reception.

I will attend the Welcome Reception

I will attend the Oration

Section 3 - Partial Registration Information - Symposium Registration, Partial Registration, Day Registration

Day registration is available for delegates unable to attend the full conference. Day registration includes:
Attendance to conference sessions on a single day. Access to Exhibition area on a single day.
Conference satchel with complete conference program, Morning and Afternoon Teas on the day, Lunch on the day

The two day Symposium is included in the full four day registration however it can be purchased separately.

Section 4 - Social Function Tickets

The Welcome Reception is included for delegates with a full registration, if you need to purchase a ticket for the Welcome Reception or you wish to get an additional ticket for your partner to attend the Welcome Reception you can do so here.

The Conference Dinner is an optional extra, if you wish to attend you will need to purchase a ticket here. The dinner tickets include a beverage package. Pre- dinner drinks start at 7.00pm for dinner at 7.30pm.

Please view additional Social Programs and Tours available associated with this conference on our website including Special End of Conference Event and how to book these.

The Tall Ships Dinner Cruise on Friday night: tickets are limited to 2 per delegate; Price $110.00 per ticket.

Dress Code:  After 5,  Lounge Suit

Dinner tickets are $60.00 for Three Day and Four Day Registrations.

Dinner tickets for all other attendees are $139.00.

Extra Welcome Reception Tickets are $75.00 each

 

Conference Dinner or Extra Welcome Reception Tickets	None SelectedWelcome Reception Ticket Full Delegate Conference Dinner Ticket Accompanying Person Dinner Ticket Dinner Ticket - Day Delegates and Symposium Attendees Tall Ships Dinner Cruise
	None SelectedWelcome Reception Ticket Full Delegate Conference Dinner Ticket Accompanying Person Dinner Ticket Dinner Ticket - Day Delegates and Symposium Attendees Tall Ships Dinner Cruise
	Total Registration Amount Due ($AUD)

Section 5 - Hotel Booking Information

Please note: If sharing a room, split deposit payments for accommodation can not be accepted. 

Your hotel booking is not confirmed until the deposit payment has been received or you provide a credit card number.  You can do this at  the payment gateway link on your tax invoice.

The balance of your Hotel bills can be settled on check out.

DO NOT book a room if you are sharing with another person with a room booking.  All room booking deposits can be paid by cheque or Credit Card guarantee to confirm the booking.

If you need a Tax Invoice for the full stay please tick this box.

Special discounted room rates are available for delegates.

To take advantage of these discounted rates please book here.
 

If booking accommodation please make a selection from all fields denoted by

Hotel	None Selected Sheraton on the Park	Note: Single (queen bed) - Double (king bed) Twin (queen beds)
Arrival Date	None Selected 27/09/2009 28/09/2009 29/09/2009 30/09/2009 01/10/2009 02/10/2009 03/10/2009 04/10/2009
Departure Date	None Selected 30/09/2009 01/10/2009 02/10/2009 03/10/2009 04/10/2009 05/10/2009 06/10/2009
Room Type	None SelectedSingleDoubleTwin
Arrival Time	Hrs01:0002:0003:0004:0005:0006:0007:0008:0009:0010:0011:0012:0013:0014:0015:0016:0017:0018:0019:0020:0021:0022:0023:00
Sharing room with nominated accompanying person
Hotel Deposit Due  ($AUD)
Special Requirements