As Trustee for the ACVA Foundation ABN 89 505 692 923 Presenting Dr Kevin May – 1 Day Lecture and Practical Workshop at Marcus Oldham College, Geelong. 9th September, 2014 Enrolment Form Acceptance into the seminar is on a first come, first accepted basis. The numbers for the course are limited to a maximum of 20 students. Full fee is AUD $600 + GST ($60) to be paid in full by 8th August, 2014 Includes all lectures, practicals, lunch, morning and afternoon tea. Payment and Registration Details Payments can be made by Cheque payable to Australian College of Veterinary Acupuncture Ltd. as Trustee for the ACVA Foundation Direct Transfer to:Account Name: Australian College of Veterinary Acupuncture Ltd. as Trustee for the ACVA Foundation Bank: Commonwealth Bank of Australia, Address: Highton, Victoria 3216 BSB: 063858, Account Number: 1022 6220. Please state your full name in comments. Please send a payment confirmation email to the Course Administrator at contact@vetacupcollege.com.au confirming your name and date of payment. Print, complete and sign the enrolment form, then either: email to: contact@vetacupcollege.com.au or Fax to: +61 3 52441693 Send your payment by direct deposit or Mail your cheque to: Australian College of Veterinary Acupuncture Ltd., PO Box 6088, Highton, Victoria, 3216. Australia. As Trustee for the ACVA Foundation ABN 89 505 692 923 EVENT: Dr K May, 9th Sept 2014 Surname: …………………………………………………… First Names: ………………………………..…….. Name for Badge: ……………………………… Degree and Institution: ………………………………………………………………………………….. Year Graduated: …………….………………………………………………………………………………. Email Address: ………………………………………………….……………………………………………. Personal Contact No: .……………………………………................................................... Home Address: ……………………………………………………………………………………………….. Town / Suburb: ………………………………………………… Postcode: …….……………………. Clinic/Business Name: ……………………………………………………………………………………. Postal Address: ………………………………………………………………………………………………… Town / Suburb: ………………………………………………… Postcode: …….……………………. Next of Kin: …………………………………… Contact No: ………………………………………... AVA membership number (for CE points) ________________________ I am: General Veterinarian Specialist ………………………………………………… Other: …………………………………………………………………….. Previous experience in chiropractic (if any)……………………………………………………… How did you hear about this course? ................................................................... As Trustee for the ACVA Foundation ABN 89 505 692 923 Assumption of Risk, Waiver and Release of Liability:Whilst every endeavour is made to provide a safe environment during the course, it is a condition for accepting the application that the course applicant acknowledges that live animals will be used in this course during the practical sessions, clinical demonstrations by course instructors, clinical workshops and practical examinations. The Applicant assumes any risks, waives any causes of action and claims of whatsoever nature and wheresoever situate and releases the Australian College of Veterinary Acupuncture Ltd (ACVA) and any independent contractors and facility providers used during the sessions from any liability resulting from damages or injuries caused by any animal. This provision shall be binding to the fullest extent of the law and shall be pleaded as a complete bar to any claim for damages or injuries or loss incurred by the Applicant during the Course. If any portion of this provision is declared to be null and void the remainder shall remain in full force and effect. The Applicant acknowledges receipt of this document and hereby acknowledges that this is a legal and binding document and the parties are bound by the terms and conditions. Sign and Date:……………………………………………………………………………………………………./………./……… Use of photographs for promotional purposes Photographs may be taken of participants during the seminar e.g. group photos or treatments during the seminar. Please tick the appropriate box:I consent I do not consent to the Australian College of Veterinary Acupuncture Ltd. as Trustee for ACVA Foundation, using any material that may contain photographs for the purpose of promoting the Australian IVAS Veterinary Acupuncture Course and allied seminars. As Trustee for the ACVA Foundation ABN 89 505 692 923 Payment Policy Veterinarians who wish to secure their place in the ACVA Dr K May lecture and practical must pay the full amount by August 8th 2014. Accommodation Accommodation and travel are not included in the course fees and are your responsibility. Marcus Oldham College, student style residences, 145 Pigdons Road, Waurn Ponds. Please indicate the nights accommodation required at cost $54 per night. And add this to the session payment. Local Motels within reasonable commuting distance include: Aristocrat Waurnvale Motel, 90 Princes Highway, Waurn Ponds. Phone 03 5241 8211 Barwon Valley Lodge, 99 Barrabool Road, Belmont. Phone 03 5247 2500 Rose Garden Motel, 14-16 Settlement Road, Geelong. Phone 03 5241 9441 Cancellation Policy Please note our STRICT cancellation policy: Due to the short lead time to arrange this lecture during Dr Mays’s visit to Australia we will not be able to offer a cancellation period. No fees will be refunded if cancellation occurs after the commencement of the course. The Australian College of Veterinary Acupuncture Ltd reserves the right to alter the dates and the order of the lectures and residential seminars detailed in this booklet and to cancel the course if necessary, in which case all fees will be refunded or held over until the rescheduled event takes place.