SeminarRegistrationForm.pdf
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Please note: This document becomes a ‘’Tax Invoice” when payment is made. If your payment is being processed through a large organization and may be delayed, please fax your form and request the original form with payment. Registrations will only be acknowledged once payment has been received. Terms & Conditions: • Patterson Medical reserves the right to cancel the seminar if minimum attendance numbers are not achieved. In such event, monies will be refunded to paid registrants. • When a registrant withdraws from a course 7 days or more to the commencement of the course, 20% of the course fee will be retained by Patterson Medical to cover administrative costs. No refund will be provided when a registrant withdraws less than 7 days prior to the course. • Substitutes are accepted with approval from Patterson Medical course organisers. For updates or more information about our range of workshops and seminars, please visit: www.pattersonmedical.com.au Or alternatively call Customer Service on 1300 473 422. Ausmedic Australia Pty Ltd ABN 92 078 944 037 Seminar: “Problem Shoulders - Solved!” PERSONAL INFORMATION Title: First Name: Last Name Organisation: Department: Address: Suburb: State: Postcode: Telephone: Fax: Email: Name on Badge: PAYMENT DETAILS (please tick payment method): Cheque payable to: Patterson Medical Credit Card Card Type (please circle): Mastercard / VISA / AMEX (AMEX payments attract a fee of 3% of the transaction total) Card Number: Expiry Date: Name on Card: Signature: FAX / EMAIL / MAIL THE COMPLETED FORM TO: Fax: 1300 766 473 Email: [email protected] Post: Patterson Medical, PO Box 1006, North Ryde NSW 2113 Please complete all sections of this form to ensure your registration is processed correctly and efficiently. Wednesday 11 November 2015 NSWIS Building (NSW) $25.00 (GST incl)
Transcript of SeminarRegistrationForm.pdf
Please note: This document becomes a ‘’Tax Invoice” when payment is made. If your payment is being processed through a large organization and may be delayed, please fax your form and request the original form with payment.
Registrations will only be acknowledged once payment has been received.
Terms & Conditions:• Patterson Medical reserves the right to cancel the seminar if minimum attendance numbers are not achieved. In such event, monies will be
refunded to paid registrants.• When a registrant withdraws from a course 7 days or more to the commencement of the course, 20% of the course fee will be retained
by Patterson Medical to cover administrative costs. No refund will be provided when a registrant withdraws less than 7 days prior to the course.
• Substitutes are accepted with approval from Patterson Medical course organisers.
For updates or more information about our range of workshops and seminars, please visit:www.pattersonmedical.com.auOr alternatively call Customer Service on 1300 473 422.
Ausmedic Australia Pty Ltd ABN 92 078 944 037
Seminar: “Problem Shoulders - Solved!”
PERSONAL INFORMATION
Title: First Name: Last Name
Organisation:
Department:
Address:
Suburb: State: Postcode:
Telephone: Fax: Email:
Name on Badge:
PAYMENT DETAILS (please tick payment method):
Cheque payable to: Patterson Medical
Credit Card Card Type (please circle): Mastercard / VISA / AMEX (AMEX payments attract a fee of 3% of the transaction total)
Card Number: Expiry Date:
Name on Card:
Signature:
FAX / EMAIL / MAIL THE COMPLETED FORM TO:
Fax: 1300 766 473 Email: [email protected]: Patterson Medical, PO Box 1006, North Ryde NSW 2113
Please complete all sections of this form to ensure your registration is processed correctly and efficiently.
Wednesday 11 November 2015 NSWIS Building (NSW) $25.00 (GST incl)
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