As Trustee for the ACVA Foundation ABN 89 505 692 923
Presenting Dr Mark Hocking – Day Lecture and Practical
Workshop at Marcus Oldham College, Geelong.
14th 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 32 students.
Full fee is AUD $526 (incl GST) to be paid in full by 8th August, 2014
Includes all lectures, notes, 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 M Hocking – Trigger Point Workshop, 14th 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/acupuncture (if any)…………………………………
How did you hear about this course/seminar?
............................................................................................................................
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
Participants who wish to secure their place in the ACVA Ltd Dr M Hocking 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 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.