Palliative Care registration

Australasian Pallative Care Training Organisation

Registration Form

For Workshops and Workshop Facilitator Training
and Special Interest Units

Please Note:

A printable version of the registration form is available ( click on the Logo above)
Just print, fill in your details and mail to:

Australasian Palliative Care Training Organisation
GPO BOX 2820
BRISBANE QLD 4001

PLEASE FILL IN All SECTIONS OF FORM MARKED with an asterisk - * (others are optional)

Personal details:

Name

Address City Post Code State

Area Code Phone

Please register me for the following workshop:

RAA
2 Day Palliative Care & Conscious Dying Workshop Cost: $220

RAA - Intensive
1 Day Palliative Care & Conscious Dying Workshop. Cost: $150

Please register me for the 1 week Intensive Workshop Facilitator Course:

PCTT Palliative Care & Conscious Dying Workshop Facilitator Cost: $3,300

Please register me for the Advanced 1 day Intensive Workshop Facilitator Teacher's Course:
(enabling Facilitators to train to deliver the 1 week Intensive Workshop Facilitator Course)

PCTT- A Advanced FacilitatorTeacher Training Cost: $ 990

Please supply the Palliative Care Facilitator Training Kit:

PCTT- B Palliative Care Facilitator Training Kit Cost: $300

Please supply the Palliative Care Facilitator Business System:

PCTT- C Palliative Care Facilitator Business System Cost: $500

Please register me for the following Distant Learning Special Interest Unit(s): $220 each unit

PAC Death and Children	PAD Needs of the Dying	PAE Conscious Dying
PAG Aromatherapy for Palliative Care	PAH Caring Touch for Palliative Care	PAI Music for Palliative Care
PAJ Colour for Palliative Care

Date:

Payment details:

Cheque Money Order Direct Debit *

* We shall contact you with account details for Direct Debit :