Lung Health Promotion Centre at The Alfred

ABN: 27 318 956 319

2012 Course Registration Form & Tax Invoice

Refunds & Cancellations

No refund will be given for cancellations made within 5 working days of a course starting date.

A $35 administrative fee will be retained from each refund.

Please note: Course places are limited and are confirmed upon full payment of course fees, at least 2 weeks prior to the date of the course.

NB: All courses are tax deductible.

Refunds & Cancellations

No refund will be given for cancellations made within 5 working days of a course starting date.

A $35 administrative fee will be retained from each refund.

Please note: Course places are limited and are confirmed upon full payment of course fees, at least 2 weeks prior to the date of the course.

NB: All courses are tax deductible.

I would like to register for the following program(s):

** All course fees are GST inclusive

Asthma Educator’s Course $690

Wed 21–Fri 23 March  Wed 18–Fri 20 July

Wed 14 – Fri16 November

Educating Presenting With Confidence $250

Tuesday 20 March  Tuesday 17July

Tuesday 13 November

Smoking Cessation Facilitators Course $580

Thurs 8 – Fri 9 March Thurs 26– Fri 27 July

Thurs 1 – Fri 2 November

Asthma Management Update $250

Wednesday 16 May

Paediatric Respiratory Update $250

 Wednesday13 June

Happiness, ResilienceWellbeing For Life & Work $250

Wednesday 20 June

Theory & Practice of Non Invasive Ventilation

- Bi-Level & CPAP Management $250

Friday 8 June

Respiratory Clinical Update $250

Thursday 3 May

Respiratory Course $915

Wed 30 – Thurs 31 May, Fri 1 June / Wed 27 – Thurs 28 June

Wed 19 – Fri 21Sep / Wed 24 – Thurs 25October

Managing COPD - There IS something you can do! $520

Thurs 26 – Fri 27April  Thurs 6 – Fri 7Sep

Thurs 22 – Fri 23November

Introduction to Spirometry Workshop (½day)$130

 Friday 24 August

Spirometry Principles & Practice $690

Thurs 23 – Fri 24Feb  Mon 26 – Tues 27 Mar

Mon 28 – Tues 29 May Thurs 9 – Fri 10August

Thurs 29 – Fri 30Nov

Please forward registration form payment to the:

Lung Health Promotion Centre

The Alfred, PO Box 315, Prahran, Vic, 3181

Tel: (03) 9076 2382 Fax: (03) 9076 3434

Email:

Website:

Name: ...... …......

Address: ...... ….....

...... P/C: ...... ….....

Is this address  business?  home?

Work phone: ...... …...

Mobile: ………………………………………………….

Home phone: ...... …....

Fax: ……………………………………………….….….

E-mail: …………………………….………………….…

Gender: M / F

Occupation/Profession: …………......

Organisation: ...... …......

The Centre complies with the Victorian Information Privacy Act 2001. Personal information about current & potential participants will be used only for the purposes collected & in accordance with the Centre’s policies & procedures. Please mark the box if you do not wish your details to be included in:

the Centre’smailing list the Centre’s email listing

a course participant list list to the Centre’s partners

DISCOUNTS:

Early Bird Discount:

10% off total course fee(s) when paid in fullat least 4 weeks prior to the course date.

Multiple Course Bookings:

Receive the following discounts when you pay in full for 2 or more courses at the same time

$20 off any 1 day program $35 off any 2 or more days program

Money enclosed?  Yes No

 Cheque/money order

(Payable to: Lung Health Promotion Centre)

 Credit card Cash (Amount enclosed: $...... )

Credit Payment details

Please charge my: (tick box)

 Bankcard Mastercard

 Visa Other …………………..

Card No:

└┴┴┴┘└┴┴┴┘└┴┴┴┘└┴┴┴┘

Name: …………………………………………………

Signature: ……………………………………………….

Expiry date: …………………………………......

Refunds & Cancellations

No refund will be given for cancellations made within 5 working days of a course starting date.

A $35 administrative fee will be retained from each refund.

Please note: Course places are limited and are confirmed upon full payment of course fees, at least 2 weeks prior to the date of the course.

NB: All courses are tax deductible.