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ASUM CPD WORKSHOPS
Melbourne:
Breast Workshop
DATE
Saturday 20th June 2015
TIME
Start: 8.30am for 9.00am
Finish: 3.30pm
Morning tea & lunch included
VENUE
Radiology Lecture Theatre
Level 2, South East Wing
Royal Melbourne Hospital
REGISTRATION FORM Editable Document for fast and easy completion 300 Grattan Street
All fields must be completed. Please use  or  to complete all relevant check boxes Parkville, VIC 3050
Are you a current ASUM Member?
 Yes Member Number:
 No  Membership Application Attached (see below) CPD POINTS
MAKING THE MOST OF ASUM
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15 months for the price of 12 months! BECOME AN ASUM MEMBER
REGISTRATION FEES
DMU Students: Free
Members: $70
 Event registration fee for Members is only $70, & with at least 4 events being Non-members: $200
held per state why not enjoy great savings & benefits for the next 15 months BECOME AN ASUM MEMBER
 Click here for our event calendar ASUM CPD FORTHCOMING EVENTS
 ASUM Membership Special 15 FOR 12 is now available for $428
(membership year concludes 30th June 2016)
RETURN FORM(S) VIA
Fax: (02) 9438 3686
Email: events@asum.com.au
Name:
Title / First name / Surname
Gender:
M
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D.O.B: / /
 Home
Suburb:
State:
Phone: Work ( )
Registration closes:
Monday 15th June 2015
 Work
Postcode:
Mobile:
ENQUIRIES
Cathy McCully
Events Assistant
Ph (02) 9438 2078
events@asum.com.au
Email:
Special dietary requirements:
Payment:
 MasterCard
 Visa
 Bank Draft in Australian Currency
 Australian Money Order  Cheque (in AU$ drawn on an Australian Bank)
Credit Card No:
Highlight and replace boxes below with relevant numbers
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Cardholder’s Name:
Date: / /
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+612 9438 2078
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Cancellations and Refunds: ASUM reserves the right to re-schedule this event if insufficient registrations are received.
A cancellation request must be received in writing to ASUM Head Office at least 7 days prior to this event. No refund
will apply after this date. Return this form via email to events@asum.com.au or by faxing to +61 2 9438 3686.
If you do not receive a confirmation of receipt within 7 business days of submitting your application (allowing for delivery
with postal applications and processing time), please contact the ASUM office on +61 2 9438 2078.