MRO 2015 Update Course - Registration Form

Transcription

MRO 2015 Update Course - Registration Form
AMROA Update Course
for credentialled Medical Review Officers
Friday 24 July 2015
Vibe Hotel Sydney
111 Goulburn Street, Sydney, NSW.
ABN 65142689727
AMROA invites registered medical practitioners who
have passed either the AMROA, the MROCC or the
AAMRO examination within the past five years to
attend the Update Course.
This program, delivered by a team of experienced
MROs and toxicologists, offers course participants
small class participatory learning opportunities and
peer to peer discussion about new developments in
Australasian MRO Theory and Practice. The course
has been designed to be of interest to existing MROs
wishing to maintain validity as an AMROA
credentialed MRO, and for those MROs looking to
simply update their existing knowledge in a
supportive collegiate environment.
Course
participants will also have the opportunity to discuss
their difficult cases and review research papers in a
small group learning environment.
Course participants are eligible to retain membership
of AMROA for a further five years following
completion of the course and continue to be
recognised as MROs for purposes of CASA DAMP
MRO management. There is no exam requirement
associated with this course.
Please attach certificate of completion of MRO exam.
Course notes
will be distributed in soft copy
1/7/15. Hard copy notes available on request by
10/7/15.
Accommodation
is available at the venue,
Vibe Hotel Sydney ($180 per room per night incl
breakfast). To make a booking, please contact the
hotel direct on 02 8272 3300 and quote AMROA
.
Confirmation,
Cancellations
and
Refunds - All registrations will be acknowledged in
writing with confirmation of your place in the course.
Cancelled registrations will receive a 50% refund prior to
21/05/15. No refunds on cancellations after 21/05/15.
AMROA AGM & Annual Dinner
will be held on Thursday 23 July at 6.30pm at Vibe Hotel.
Registration fee for the Annual Dinner is $90. Please
indicate your intention to attend.
MRO UPDATE COURSE – REGISTRATION FORM
Update Fee: $500.00 – AMROA members $650.00 – Non-members
Surname ______________________________ First Name ______________________ Title: _________
Address ___________________________________________________________________________
City ____________________________________________ State _______ P’Code ________________
Mobile _________________________________ Email: ______________________________________
Medical Specialty:____________________ Dietary Requirements: _____________________________
Annual Dinner & AGM ($90)
I will attend / I will not attend (please indicate)
Please attach copy of certificate of completion of MRO exam.

Direct deposit to Australasian Medical Review Officers Assoc BSB 063 113 Account 10773445
(transaction description must include your full name)


Please charge this amount to my credit card (NO Diners or AMEX cards)
Visa
 Mastercard
Total Amount: $____________
Card No. __ __ __ __
__ __ __ __
__ __ __ __
__ __ __ __ Expiry Date: ____________
Signature: ___________________________ Cardholders Name: _______________________________

Cheque payable to AMROA
AMROA, PO Box 4022, Balwyn 3103
[email protected]
T +61 3 9899 1686
F +61 3 9890 2353