2012 Online Registration Form

Title:
Surname:
Given Name:
Mailing Address:
City:
Post Code:
State:
Email:
Phone Number:
Fax Number:
Mobile Number:

Westmead Hospital, Hawkesbury Road, Westmead. Lecture Theatres 2 & 3

Day 1 THURSDAY, 23 AUGUST. (please tick)
Workshop 1 - $300.00 9am - 4pm Couples Therapy.

Workshop 2 - $150.00 9am - 12pm Brief Dynamic Psychotherapy in the Conversational Model.
Workshop 3 - $150.00 1pm - 4pm Introduction to the Conversational Model.

Day 2 FRIDAY, 24 AUGUST.
Workshop 4

9am - 5pm Complex Trauma: “From Trauma to Recovery” $60

Separate payment must be made for this day (DO NOT PAY ANZAP).


To pay for this presentation please download the Registration document or telephone 02 9845 9693 and quote Cost Centre 356902/1057. Please then register and notify your receipt number to Michelle Phillips as follows:

Tel: 02 9840 3335 - Fax: 02 9840 3572
Mail: Michelle.Phillips@swahs.health.nsw.gov.au

WESTMEAD HOSPITAL, JOHN LOWENTHAL AUDITORIUM

(please tick)
Conference Day 1 - $250.00    Saturday 25th August.

Conference Day 2 - $250.00    Sunday 26th August.


ANZAP Members Only Conference Both Days $460
Accredited Training Program Candidates receive a discount of 20%. Evidence of training must be produced. Conference speakers are required to register. No refunds will be given for cancellations after 16 August 2012.
   

Method of Payment

   
Cheque or Direct Deposit
Credit Card (Visa or Mastercard)
   
Notes:
Payment Screen Next