2016 members’ Christmas party · 2016 members’ Christmas party Complimentary tickets include:...
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------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 2016 members’ Christmas party REGISTRATION FORM Contact information: please provide details of a current RACGP or AMA(SA) member Title: ___________ First name: ____________________________________________ Last name: ____________________________________ Organisation: __________________________________________________________ RACGP No./ AMA(SA) no. ________________________ Address: ______________________________________________________________________________ Post code: _____________________ Telephone: ___ - __________________________ Fax number: ___ - ____________________ Mobile number: __________________________ Email: _______________________________________________________________________________________________________ GUEST INFORMATION: Adults TITLE / FIRST NAME / LAST NAME ________/____________________/_____________________ ________/____________________/_____________________ ________/____________________/_____________________ ________/____________________/_____________________ GUEST INFORMATION: Children NAME AGE GENDER (TICK RELEVANT BOX) (CIRCLE ONE) ________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL ________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL ________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL ________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL To register your attendance, please fill in the registration form and return via email to: [email protected], or via fax to 08 8267 8319, or via post to 15 Gover Street, North Adelaide, 5006 For queries please contact the faculty office on 08 8267 8310. PLEASE PRINT CLEARLY In addition to celebrating the festive season the night will also honour the recipients of the McCleave/ Thompson Award. 2016 members’ Christmas party Complimentary tickets include: • cocktail food and beverages • door prizes • special appearance by Santa (free photos for children) • children’s entertainment • music and much more! The RACGP SA&NT in conjunction with AMA (SA) are delighted to invite members and their families to attend the 2016 members’ Christmas party. Date: Friday 25 November 2016 Time: 6.00–9.00 pm Dress: Smart casual Venue: College House, 15 Gover Street, North Adelaide SA Cost: Complimentary RSVP: Friday 18 November 2016
Transcript of 2016 members’ Christmas party · 2016 members’ Christmas party Complimentary tickets include:...
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2016 members’ Christmas partyREGISTRATION FORMContact information: please provide details of a current RACGP or AMA(SA) member
Title: ___________ First name: ____________________________________________ Last name: ____________________________________
Organisation: __________________________________________________________ RACGP No./ AMA(SA) no. ________________________
Address: ______________________________________________________________________________ Post code: _____________________
Telephone: ___ - __________________________ Fax number: ___ - ____________________ Mobile number: __________________________
Email: _______________________________________________________________________________________________________
GUEST INFORMATION: Adults TITLE / FIRST NAME / LAST NAME
________/____________________/_____________________
________/____________________/_____________________
________/____________________/_____________________
________/____________________/_____________________
GUEST INFORMATION: ChildrenNAME AGE GENDER (TICK RELEVANT BOX) (CIRCLE ONE)________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL
________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL
________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL
________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL
To register your attendance, please �ll in the registration form and return via email to:[email protected], or via fax to 08 8267 8319, or via post to 15 Gover Street, North Adelaide, 5006For queries please contact the faculty of�ce on 08 8267 8310.
PLEASE PRINT CLEARLY
In addition to celebrating the festive season the night will also honour the recipients of the McCleave/Thompson Award.
2016 members’ Christmas party
Complimentary tickets include:
• cocktail food and beverages • door prizes • special appearance by Santa (free photos for children)• children’s entertainment • music and much more!
The RACGP SA&NT in conjunction with AMA(SA) are delighted to invite members and their families to attend the 2016 members’ Christmas party.
Date: Friday 25 November 2016 Time: 6.00–9.00 pmDress: Smart casual Venue: College House, 15 Gover Street, North Adelaide SA Cost: ComplimentaryRSVP: Friday 18 November 2016
