Registration Without Payment UICC

The 15th UICC Reach to Recovery International Breast Cancer Support Conference - May 13 to 15, 2009 Brisbane Convention and Exhibition Centre, Brisbane, Australia

To register please complete the form below with your personal detail and click on the Send Registration button at the bottom of the page.

Your details will be kept for use in managing this conference only, unless otherwise advised.
 
The fields in BLUE are required.

Section 1 ABN: 88010606694

Title

First Name

Family Name

Badge Name

(only if different from above)

Organisation

(if applicable)

Address Line 1

Address Line 2

Suburb/City

State

Postal/ZIP Code

Country

(Required)

Phone

Fax

Mobile Phone

E-Mail Address

please ensure address is spelt/formatted correctly

Is this your Work Address?

Dietary Requirements

Other Requirements

wheelchair access etc

Send Correspondence

E-Mail

Fax

Mail

Participant Profile (please choose one catagory)

Clinician:	Nurse:	Breast Cancer Survivor:
Partner/Family/Friend:		Other Health Professional:

Accompanying Person Information

You only need to complete this section if you will be purchasing an Accompanying Person Registration (see details in section 2)

Title

(Mr, Mrs, Dr, Prof, etc)

First Name

Surname

Badge Name

(only if different from above)

Dietary Requirements

Section 2 - Full Registration

Conference Registration includes:

Standard (after February 12, 2009) $AUD495

Pre-conference workshop day
Welcome Reception at Parliament House
Three days of conference (all sessions), including the Adventure Workshop at Riverlife
Ticket to Conference Dinner at Brisbane City Hall
Morning/afternoon teas and lunches throughout Conference
Conference satchel including name badge and conference information

You can book an Accompanying Person Registration in Section 4
The Pre-Conference Workshops on Tuesday, May 12 can only be attended by Full Delegates, not day only registrations.

Single Day* $AUD165

Accompanying Person** $AUD195

Additional tickets for Conference Dinner $AUD120

Note:

* Single day registration includes access to all conference sessions held on a single day, morning/afternoon teas and lunch for that day, but does not include a conference satchel, or admission to the Welcome Reception or Conference Dinner.

** Accompanying Person registration includes admission to the Welcome Reception, Conference Dinner and Adventure Workshop, but does not include access to the conference sessions, morning/afternoon teas and lunches or a conference satchel.

Registration Type

($AUD)

Please indicate whether you will attend any of the following:

Note: Workshops, symposium or training session are only available to full delegates.

I will attend the free Pre-Conference Workshops on Tuesday, May 12

I will attend the Welcome Reception at Parliamant House on Tuesday, May 12

I will attend the Conference Dinner at City Hall on Thursday, May 14

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

Day registration is available for delegates unable to attend the full conference. Day registration includes:
access to all conference sessions held on a single day, morning/afternoon teas and lunch for that day, but does not include a conference satchel, or admission to the Welcome Reception or Conference Dinner.

In this section you can also book the:

>> Specialist Breast Care Nurses Symposium on Tuesday, May 12th - Cost $100 for full delegates ($500 for Day only).
>> Lymphoedema For Heath Professionals Training on Tuesday, May 12th - Cost $100 for full delegates ($500 for Day only).

You can only attend one of these as they are held concurrently.

Make your selection(s) from the drop downs, you can only choose one option per drop down box.

Day Only			Amount ($AUD)
Day Only			Amount ($AUD)
Day Only			Amount ($AUD)
Symposium or Training			Amount ($AUD)

Section 4 - Social Programme

All Social function tickets for non delegates have been now been sold.

~~Purchase a ticket here~~

Amount ($AUD)

~~Purchase another ticket here~~

Amount ($AUD)

~~Purchase another ticket here~~ Amount ($AUD)

Total Registration Due ($AUD)

Section 5 - Hotel Bookings - if you do not require accommodation tick this box

Open the Accommodation Guide window here before making a booking or tick one of the following: I am interested in: Using the Home Stay program \| Do not need Accommodation
Mandatory Fields**		You can provide a credit card number on the Conference payment gateway as security for the hotel deposit. The email link to the gateway will be sent to you by email in the next 24 business hours.
Hotel**
Arrival Date**
Departure Date**
Room Type**
Arrival Time

I will be sharing the room with the nominated accompanying person
Special Requirements
Hotel Deposit Due ($AUD)
Section 6

Cancellations and Amendments

Registration cancellations and amendments must be sent in writing either by mail, fax or email to AST Management Pty Ltd. Registration cancellations received at least 31 days prior to the conference will receive a full refund less $125 administration fee. Registration cancellations received less than 30 days and at least 15 days prior to the conference will receive a 50% refund. No refunds will be given for registration cancellations received within 14 days of the conference. As an alternative to cancellation your registration can be transferred to another person at least 15 days prior without receiving any extra cost penalty. Transfers made 14 days prior and less will incur a $20.00 transfer fee.

When you click on submit registration you will be transferred to our secure payment gateway. Your credit card details will be checked manually and submitted for payment. You will receive a transaction confirmation in the next 12 business hours.

Built and hosted by AST Conference Management 2008 Ph: 07 5528 2501 Fax: 07 55285291