Platinum Sponsor 2014-2016
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ASUM CPD WORKSHOPS
DATE
Saturday 7th February 2015
Townsville: Gynaecology &
Early Pregnancy Ultrasound
TIME
Start: 8.30am for 9.00am
Finish: 3.30pm
Morning tea & lunch included
VENUE
Robert Douglas Auditorium
The Townsville Hospital
100 Angus Smith Drive
REGISTRATION FORM Editable Document for fast and easy completion Douglas QLD 4814
All fields must be completed. Please use  or  to complete all relevant check boxes
Are you a current ASUM Member?
 Yes Member Number:
CPD POINTS
 No  Membership Application Attached (see below) 5.5 MOSIPP/ASAR points
MAKING THE MOST OF ASUM
5 RANZCOG points
Half Yearly Membership available from 1st of December!
 ASUM Half Year Membership fee for Sonographers is available for $224
(membership year concludes 30th June 2015)
 Event registration fee for non-members is $200, so for only $24 extra
enjoy many savings and benefits over the next 7 months
 Click here for more information BECOME AN ASUM MEMBER
REGISTRATION FEES
DMU Students: Free
Members: $70
Non-members: $200
BECOME AN ASUM MEMBER
RETURN FORM(S) VIA
Fax: (02) 9438 3686
Email: events@asum.com.au
Name:
Title / First name / Surname
Gender:
M
Postal Address:
F
D.O.B: / /
 Home
Suburb:
State:
Phone: Work ( )
Registration closes:
Friday, 30th January 2015
 Work
Postcode:
Mobile:
ENQUIRIES
Cathy McCully
Events Assistant
Ph (02) 9438 2078
events@asum.com.au
Email:
Special dietary requirements:
Payment:
 MasterCard
 Visa
 Bank Draft in Australian Currency
 Australian Money Order  Cheque (in AU$ drawn on an Australian Bank)
Credit Card No:
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Amount: $
Cardholder’s Name:
www.asum.com.au
+612 9438 2078
Date: / /
Cardholder’s Signature:
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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 by faxing to +61 2 9438 3686 or via email to asum@asum.com.au
If you do not receive a confirmation of receipt within 1 week of submitting your application (allowing for delivery with
postal applications and processing time), please contact the ASUM office on +61 2 9438 2078.