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Registration Brochure 30 AUGUST – 1 SEPTEMBER 2012 Atrium Hotel Mandurah, Western Australia
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Page 1: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

Registration Brochure

30 AUGUST – 1 SEPTEMBER 2012Atrium Hotel Mandurah, Western Austral ia

Page 2: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

Community Health Nurses WA was incorporated in 2003 to enable our organisation to

grow in the professional interests of nurses specialising in community health.

Our logo is designed to show that we are focussed and moving forward.

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The Community Health Nurses of Western Australia

conference organising committee invites you to attend the

10th biennial Community Health Nurses National Conference.

Once again, a selection of exciting keynote speakers will

present topical information on today’s hot issues.

The theme this year is “From Little Things Big Things Grow”.

Taken from a Paul Kelly song, it encapsulates the work that

Community Health Nurses do in supporting our community.

The song describes the eight year wait and struggle of

the Gurindji Aboriginal people for land rights and better

conditions, a people marginalised in society, politics, health

and education, not dissimilar to many of our clients. Today

we provide services for all families and children from birth until

adulthood. Early interventions can have profound positive

outcomes for individuals and communities later in life.

The conference will provide a wonderful chance to network

with old friends, make new acquaintances, share innovative

ideas and practices. This is an opportunity to feel inspired by

exceptional professionals from your field and to explore the

vibrant and cosmopolitan hub of Mandurah.

Pat KlauzOrganising Committee Chairperson

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Hosted By:

Page 4: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

Dr Richard Fletcher PhDFathers and Families Research Program,

University of Newcastle

Richard Fletcher is a senior

lecturer in the Family Action

Centre, Faculty of Health at The

University of Newcastle, NSW. He

has been conducting programs

and research with boys, fathers

and families for over 20 years and

is the convenor of the Australian

Fatherhood Research Network.

His current research includes:

father’s role in families with PND; young parents’ strengths;

father-infant attachment; indigenous fathering; fathers of

children with autism; using the web for parent support; and,

supporting separated parents of young children. His book

‘The Dad Factor: how father-baby bonding helps a child for

life’ was published by Finch in March 2011.

Professor Stephen HoughtonUniversity of Western Australia

Winthrop Professor Stephen

Houghton is Director of the

Centre for Child and Adolescent

Related Disorders, at the

University of Western Australia.

He is a registered psychologist

whose research activities are

empirical based and focus

on childhood and adolescent

psychopathology, developmental

trajectories to delinquency, and the construct of juvenile

psychopathy and the development of antisocial behaviour.

Stephen has published several books and over 150 articles

in internationally refereed high impact journals and has

attracted over 25 externally competitive grants in his field of

research.

Gabrielle BrandCommunity Youth Health, Primary Health Care,

Nursing Education, Murdoch University

Gabrielle Brand completed a

Bachelor of Nursing in 1996

at Edith Cowan University in

Western Australia. Following 5

years in clinical practice, Gabrielle

completed a post graduate

qualification in Community

Health Nursing in 2001 at Curtin

University and worked as a Youth

Health Nurse in the Peel region.

She was awarded the Vice Chancellor’s Excellence in

Teaching Award from Murdoch University in 2006 following

development of Family and Community Health care unit and

innovative teaching methodologies in the new undergraduate

nursing curricula at the Murdoch University Peel campus.

She was the inaugural winner of the Joan Hardy Scholarship

for post-graduate nursing research in 2008 for her Masters

in Nursing Degree. Gabrielle has published and presented

her research in the area of Nursing Education, focusing on

strengthening nursing student’s personal and professional

capacity through the use of photo-elicitation techniques, and

realistic pre-practice reflection and education prior to clinical

placements.

Gabrielle was awarded an Australian Post-Graduate Industry

scholarship to complete a Doctor of Philosophy in 2009. Her

research uses a narrative approach to explore how pregnant

and young mothers understand, experience and respond

to motherhood in the Peel community. Fundamental to this

research’s purpose is the premise that to improve planning

and delivery of more appropriate, holistic health and social

services, we need to share, explore and understand the social

worlds of young mothers. By listening and encouraging the

young mothers to voice their experiences of motherhood, this

research project will evoke wider awareness and stimulate

more innovative thinking about how we can deliver alternate

models of support in the community.

Keynote Speakers

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Thursday 30 August

1.00pm – 5.00pm Registration Desk Open

2.00pm – 5.00pm Presentations In The Exhibition Area

POSTERS Year 6 Immunisations QI Project

Elizabeth Harding, Andrea Padley, Kaz Knudsen, Vani Naidoo, Jo Padgett & Jane Skoll,

Armadale Community Health Centre

The Parents Place

Roberta Malloy, The Parents Place – Mandurah

Immunisation Alliance of WA: Who are we?

Martina Baker & June Doyle, Immunisation Alliance WA

Early Years Calendar

Sarah Lohmeyer & Dianne Mazzucato, High Wycombe Child Health Centre

Improving Access to Renal Services in the Goldfields

Brigette Colwell, WACHS

3.00 – 3.30pm Taking Playgroups Beyond Play: A simple

WORKSHOPS model with real impacts for later life

Chris Hawkes & Carole Michie,

Playgroup WA

3.30 – 4.00pm Assisting Community Health Nurses to

Recognise and Assess Emerging Child and

Adolescent Mental Health Concerns in the

School Setting:

Development of a training program

Anita Moyes, Child & Adolescent Community Health

4.00 – 4.30pm ‘Growing Healthy Schools’ the West Australian

Healthy Schools Project

Irene Alvarez-Hostos, Chrissy Halton &

James Stewart, Child & Adolescent Health

6.00 – 8.00pm Welcome Drinks

Programme(subject to change)

“But it’s just too confronting”: Assisting

Community Nurses to Assist Mothers and

their Children Living in the War Zone of

Domestic Terror

Kathy Blitz-Cokis, Women & Newborn Health

Service, Nicola Coleman, Community Health

Nurse & Maggie Woodhead,

Child & Adolescent Community Health

The State of Perinatal Mental Health in

the South West

Melanie Marsh, WACHS South West

Perinatal Depression in Ellenbrook: A

localised response using contemporary

health promotion practices

Nigel Carringlton, Child & Adolescent

Community Health Health Service, Jacinta

Ellis, City of Swan & Miriam Krouzecky, Child

& Adolescent Community Health Service

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Raising Awareness of Perinatal Depression

in Community Settings Across Western

Australia

Renae Gibson, WA Perinatal Mental Health Unit

Page 6: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

Programme

Friday 31 August

8.00am – 5.00 pm Registration Desk Open

8.30am Welcome to Country & Conference

9.30am Keynote Speaker

Childhood Psychopathology and the Inevitability of Armageddon?

Winthrop Professor Stephen Houghton, UWA

10.30am Morning tea

11.00am – 4.15pm CONCURRENT SESSIONS

11.00am Big Issues for Little People: Consistent sleep

information and resources for WA parents

Megan Knuckey & Ann Blunden, Child & Adolescent

Community Health

11.30am How Ngala clinicians Translate theoretical

Knowledge of Early Brain Development into Practice

Julie Holschier & Wendy Muller, Ngala

12.00 noon Pilot Study to Investigate the Feasibility of

Shopping Centre Parenting Sessions

Jan Lettenmaier & Anthea Downsborough,

Joondalup Child Health Centre

12.30pm Lunch

1.30pm Kindergarten Screening – A collaborative approach

Fran Barwick & Deborah Gayton, Child &

Adolescent Community Health

1.55pm Planting the Seed to Coordinated Approach and

Watching it Grow: The Tranby Project

Joanne Davies & Peta Welten, Child & Adolescent

Community Health

Starting Small, Staying Strong – The

graduate registered nurse program –

Community Health

Hilary Giles, Child & Adolescent Health Service

A Study to Evaluate a Nurse Education

Program in a Developing Country

Jill Smith & Catherine Ward

A Journey of Self-Discovery: Leadership

and manager development in community

health

Julie Branley & Alison Blake, Child &

Adolescent Health Service

Nursing Students Apply a School Model

in Field Work Practice in Rural India

Jane Bahen, Heart Foundation

A Standardised Way for WA Community

Health Nurses to Classify Client Acuity

Trulie Pinnegar & Karen Forde, Child &

Adolescent Community Health

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(subject to change)

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Programme

2.20pm Promoting Ear Health Programs in Schools:

A partnership between health and education

staff, children and families

June Doyle, South Metropolitan Area Health Service

& Dr Eli Ristevski, Monash University

2.45pm Afternoon tea

3.15pm Keynote Presentation

You Don’t Know Half the Story: Deepening the dialogue with young mothers

Gabrielle Brand, Murdoch University

4.15pm Close

7.00pm Conference Dinner, Catch 22 Restaurant, Dolphin Quays

Saturday 1 September

8.00 am – 4.00 pm Registration Desk Open

9.00am Chair: Welcome

9.15am Keynote Speaker

The Dad Factor

Dr Richard Fletcher PhD, University of Newcastle

10.15am Morning tea

Aboriginal Health Symposium

Since 2010 Australia has had a national focus of ‘Closing the Gap’ in the significant discrepancy

in life expectancy and mortality of Aboriginal and Torres Strait Islanders. This symposium is an

opportunity for you to hear about the innovative services and programs being run in both rural

and metropolitan settings.

10.45am Boodjari Yorga & Koolangka Project

Assimina Di Lollo & Sharlene Abbott, WACHS South West

11.05am Growing Together – Engaging with Aboriginal Community

Leonie Hellwig & Tyra Thomas, Child & Adolescent Community Health Service

11.25am Culturally Appropriate Child Health Services for the Perth Metropolitan

Aboriginal Community – Can it be done?

Kirsty Skoglund, Diann Peate & Elizabeth Watson, Child & Adolescent Community Health

11.45am Goldfields Aboriginal Antenatal Program (ACAP)

Pamela Martin & Kitty Maujean, Kalgoorlie-Boulder Community Health

12.05pm Boodjari Yorgas Family Care Program

Torna Moya, Armadale Health Services

A Framework for Promoting Mental Health

in Primary Schools

Maria Hart & Stephen MacDonald, Kids Matter

Primary

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Page 8: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

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ATRIUMMANDURAH

MANDURAHCHALETS

CATCH 22RESTAURANT

SEASHELLSMANDURAH

Programme

12.25pm Aboriginal Maternity Group Practice – Supporting Aboriginal families to have healthier babies

Helen Carter, South Metropolitan Area Health Service, Nola Naylor, Denise Puddick,

GP Down South, Debbie Cherry, Aboriginal Health Officer,

Shirley Viti, Aboriginal Grandmother & Lynn Doherty, Midwife

12.45 Q & A

1.00pm Lunch

2.00pm Plenary Session

Ethical Implications in the Breastfeeding and Bedsharing Debate

Catherine Fetherston, Murdoch University

3.00pm Closing Ceremony

Make sure you are still at the conference for an energising and fun close to two days of learning

and networking.

3.45pm Summary and Close

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(subject to change)

Page 9: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

Social Programme Welcome reception Thursday 30 August 2012

Venue: Atrium Hotel, Mandurah

Time: 6.00pm – 8.00pm

Dress: Smart Casual

Cost: Included in the cost of registration for full delegates.

$45.00 for all others.

Conference dinner Friday 31 August 2012

Venue: Catch 22 Restaurant, Dolphin Quay Marina

Time: 7.00pm – Midnight

Dress: Smart

Cost: $80 per person (not included in the cost

of registration)

Catch 22 is renowned for being one of the south west’s

finest restaurants, and is known to have exceptional food

service, modern styled menus packed full of great local

produce and a distinguished atmosphere to top it off. It

is within easy walking distance of the conference venue

and other accommodation facilities in the marina area of

Mandurah.

Pre and post conference touring

For information on pre and post Conference touring please

contact the Mandurah Visitor Information Centre

Tel: 08 9550 3999

[email protected]

www.visitmandurah.com

Registration Fees and EntitlementsAll delegates, speakers and sponsors must complete

and forward a registration form.

Please complete the attached form, noting your preferences

and return to:

Community Health Nurses National Conference

Mail: PO Box 1000, Bunbury WA 6231.

Or

A confirmation letter will be forwarded once the registration

form has been processed.

Early registrations close 10 August 2012. Late registrations

will be accepted but accommodation availability may be

limited after the closing date.

Fees by 10 August after 10 August

Full CHNWA Member $400.00 $480.00

Non-Member $490.00 $570.00

Day Delegate $280.00 $280.00

Student $210.00 $210.00

Workshop only $100.00 $100.00

THE REGISTRATION FEE MAY BE FULLY TAX DEDUCTABLE IF YOU

ARE EMPLOYED IN THIS WORK AREA OR STUDYING

Please note: These prices DO NOT include GST.

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Entitlements

Fully Registered Delegates (including students)

• Attendance at all sessions

• Conference publication

• Conference satchel

• Welcome cocktail reception Thursday

• Morning, afternoon teas and lunches during

conference days

Day Delegates

• Attendance at sessions on day nominated

• Conference publication

• Conference satchel

• Morning, afternoon tea and lunch on day of attendance

Cancellation Policy

• All cancellations of attendance must be made in writing

to the Conference Secretariat

• A full refund, less a cancellation fee of $120.00, will be

made on those received before 30 July 2012

• A refund of 50% of the registration fee will be made on

cancellations received between 30 July 2010 and

16 August 2012

• No refunds will be made after 16 August 2012

• Accommodation cancellations received after

30 July 2012 may forfeit the first night’s deposit

• Accommodation deposits will also be forfeited if the room

is not occupied on the requested check in date

Registration At The Conference

There will be a serviced registration desk in the foyer outside

the Conference Room at the Atrium Hotel for the following

times during the conference. Delegates will receive their

satchel, name badge and all tickets here.

Thursday 26 August 1.00pm – 5.30pm

Friday 27 August 8.00am – 5.00pm

Saturday 28 August 8.00am – 4.00pm

General InformationDestinationMandurah, Western Australia

Set on the shores of the Peel-Harvey Estuary, Mandurah

extends along 51km of pristine Indian Ocean coastline. The

estuary is a vast expanse of water connecting the heart of

Mandurah to the slopes of the Darling Range to the east.

With a startling array of fresh-water rivers flowing into the

estuary, it’s little wonder the area’s first people named this

place Mandjar: ‘meeting place’. Located 74km south of

Perth, Mandurah is the vibrant coastal heart of the Peel

region. The city is easily accessible by car and well served

by trains from Perth.

The Mandurah Conference Centre at the Atrium Resort

Hotel is a well appointed and secluded venue offering a state

of the art venue with a creative team to deliver exceptional

service. Just a hop and a skip from the bustling marina of

Mandurah, you will wish you had more time to stay.

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Funding

There may be some funding options available to delegates

under the Commonwealth Government Rural Health

Scholarships scheme. To find out if you are eligible or for

more information phone 1800 020 787 or go to

www.ruralhealth.gov.au.

Further education funding for conferences is also available

via the Commonwealth Allied Health Rural and Remote

Scholarships: Postgraduate Scheme. For more information

contact (02) 6285 4660 or visit www.ruralhealth.org.au.

Alternate funding options and information may be available

at the Royal College of Nursing Australia to RCNA members

www.rcna.org.au, www.anf.org.au

Organising Committee

Pat Klauz June Doyle

Karine Miller Leonie Hellwig

Robyn Freeman Liz Woolfenden

Annie Carswel Jo Daly

Kim Gossage Pauline Chambers

Conference Manager

Peppermint Solutions will take care of your every need in

relation to registrations, social programs and pre and post

tours.

Contact Details

PO Box 1000, Bunbury WA 6231

Tel: 040 968 3203

Email: [email protected]

Web: www.peppermint.com.au

Insurance

Registration fees do not include insurance of any kind. It

is strongly recommended that all delegates take out their

own travel and medical insurance prior to coming to the

conference. The policy should include the loss of fees /

deposit through cancellation of your participation in the

conference, or through cancellation of the conference

itself, loss of airfares for any reason, medical expenses and

repatriation should travel arrangements have to be altered.

The Conference Manager will not take any responsibility for

any participant failing to insure. Please speak to your travel

agent or airline in regard to this matter.

Page 12: Registration Brochure - CHNWA 2012... · Teaching Award from Murdoch University in 2006 following development of Family and Community Health care unit and innovative teaching methodologies

Accommodation

There are a number of options for accommodation bookings

for the 2012 Community Health Nurses Conference. We

recommend you book early to secure the accommodation

of your choice. The conference organising committee have

secured discount rates at select properties on your behalf

and you can book this directly through the operators by

quoting “Community Health Nurses Conference” or you can

book through the Mandurah Visitor Centre.

Atrium Hotel Mandurah

Sun - Fri (those wishing to

extend & stay Sat)

Studio Room 123.00 149.00

2 Bedroom Apartment 166.00 204.00

3 Bedroom Loft 204.00 251.00

Seashells Resort Mandurah

1 brm apartment $160

2 brm apartment $250

Email booking requests to

[email protected]

Att: Kash / Michelle

Mandurah Ocean Marina Chalets

6 The Lido

Mandurah

WA 6210

Tel: 95358173

e: [email protected]

2 bedroom chalets $160.00 per night

Studio $115.00 per night

Spa chalets $160.00 per night

The Mandurah Visitor Centre website offers a booking

service and staff at the Visitor Centre will confirm your

booking within 24 hours or you can book directly with

the accommodation providers. A comprehensive list of

accommodation is available on the website.

Tel: 08 9550 3999

e: www.visitmandurah.com

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Community Health Nurses WA (hereby known as CHNWA)

and the 2012 National Conference Committee invite amateur

photographers to submit their photographs for the inaugural

CHNWA photography competition.

Photo entries will be used to showcase the many aspects

of community nursing and will capture community health

nurses in their professional and personal lives. Images will

also be used to create a community health nursing library

for use in promoting community health nursing throughout

Australia.

Tell us your nursing and midwifery story. See if you can

capture it in a photo.

This may demonstrate messages such as the care

you provide, things you’ve learnt, places you work or

communities you support.

There shall be two categories Black & White and Colour.

1st, 2nd & 3rd prize will be given for each category.

There will also be an overall “People’s Choice” award.

Size Of Prints

Print sizes shall be as follows, suitably mounted (where

applicable).

Mono: Any size up to 40cm x 50cm including mount.

Colour Prints: Any size up to 40cm x 50cm including mount.

General Conditions

SPECIAL NOTE: It is accepted that if one colour is added

to a mono (black and white) print, it remains mono.

However, if two or more colours are added, it becomes a

colour print.

1. Conference attendees and members of CHNWA

association may submit one (1) entry in each section that

they are eligible to enter.

2. All photography and artwork of the finished print must

be wholly the work of the entrant.

Inaugural Photographic Competition

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3. All entries may be commercially processed. Digital

Imaging – Computer Enhancement: The original

image must be made by the exhibitor on photographic

emulsion or acquired with a digital imaging camera. Any

modification of the original image must be made by the

exhibitor or under his/her personal direction. Images

produced from materials copyrighted by persons other

than the maker are unacceptable. Post Processing (PP)

is now open and unrestricted. Please keep in mind that

this is still a “photo” comp when applying PP.

4. Entries of all prints shall be titled and bear the author’s

name on the back. Prints must be mounted and must

include a suitable backing to cover the rear of the

picture for protection and stability. Mounted thickness

not to exceed 7mm and wood, chipboard or hardboard

mounts are not acceptable.

5. Any picture which does not conform to the competition

rules or the subject may be rejected (see Eligibility).

ELIGIBILITY: Any member/conference attendee may

challenge the eligibility of any entry before or after

judging. The matter shall be debated on the night by

the Conference Committee, and the resolution of the

meeting shall be final.

6. All competitions will be judged by conference attendees

by marking a judging slip in order of preference of 1st,

2nd and 3rd. NOTE: If a dead heat occurs the entry that

scores the most first places, becomes the place getter.

7. Consent – You need to provide a declaration of consent

for yourself as the photographer (on the application

form) as well as one for each person featured in the

photo. Consent is required for the CHNWA Conference

to show and use your photograph(s). Winning photos

become the property of CHNWA to use to promote

Community Health Nurses.

8. Images are ineligible for entry into this competition

without consent of each participant and you as

photographer.

9. You may only enter a photo you have taken personally.

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Digital photography competition application form

Photographer details:

First Name Last Name

Address

Suburb State Post code

Phone (preferred) Phone (alternative)

Email

What is the category and the story your photograph tells?

Image Title:

Photographer Consent:I, the applicant, acknowledge the photographs attached have been taken by me and I declare that:

1. I consent to the CHNWA Conference holding copyright of the photograph and holding the image in the CHNWA

association image library to use the photograph(s) for a) publishing; b) communicating to the public; and c) reproducing

the photograph(s) in materials including posters, brochures and websites; (collectively, “the Photograph Rights”) for the

purpose of promoting Community Nursing in Australia

2. I have sought permission from any people appearing in the photograph(s) for this entry to be utilised by the CHNWA

Conference a) publishing; b) communicating to the public; and c) reproducing the photograph(s) in materials including

posters, brochures and websites; (collectively, “the Photograph Rights”) for the purpose of promoting Community Health

Nursing in Australia and have attached the participant consent form(s) for each participant with this submission.

I agree not to make any claim against the CHNWA Conference Management Committee or the CHNWA association or its

officers, employees and agents arising out of CHNWA Conference or the CHNWA association exercise of the Photograph

Rights. I understand and agree that the exercise by the CHNWA Conference of the Photograph Rights will not result in

payment of any kind.

Signature:

Name:

Date:

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Photography and Film Consent[Adult to Give Consent for Self] I hereby give my consent to be filmed or photographed by Community Health Nurses

Conference and the Community Health Nurses WA Association to: a) broadcast b) publish; c) communicate to the public; and

d) reproduce the photographs in material form in materials including but not limited to film, posters, brochures and websites;

(collectively, “the Photograph Rights”) for the purpose of promoting community health.

AND/OR

[Adult to Give Consent for Minor] I am the parent/legal guardian of the minor (please print full name)

and give my consent for him/her to be filmed or photographed for Community Health Nurses Conference and the CHNWA

association and for the Conference Committee/CHNWA association to: a) broadcast b) publish; c) communicate to the

public; and d) reproduce the film or photographs in material form in materials including but not limited to film, posters,

brochures and websites; (collectively, “the Photograph Rights”) for the purpose of promoting community health.

I understand and agree that the Community Health Nurses Conference Committee and the CHNWA association may, at

any time and from time to time exercise the Photograph Rights without notice or my further consent being given. I agree

Community Health Nurses Conference committee and the CHNWA association may:

a) possess;

b) display;

c) continue to communicate to the public; or

d) continue to cause to be seen or heard in public; material without notice or my further consent being given.

I understand and agree that the exercise by the Community Health Nurses Conference committee and the CHNWA

association of the Photograph Rights will not result in payment of any kind.

I acknowledge that the Community Health Nurses Conference committee and the CHNWA association owns the copyright

and all intellectual property rights in the film or photographs, and any material in respect of which the Community Health

Nurses Conference committee and the CHNWA association has exercised the Photograph Rights.

I agree not to make any claim against the Community Health Nurses Conference committee and the CHNWA association

or its officers, employees and agents arising out of Community Health Nurses Conference committee and the CHNWA

association exercise of the Photograph Rights.

Full Name (please print):

Signature:

Address:

Date:

To enter: Please note: You must provide a photography consent form for every person in your photo.

Please print off additional copies for each individual.

Digital photography competition application form

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Community Health Nurses National Conference 2012

Please PRINT clearly. For multiple registrations please copy this form.

PERSONAL DETAILS

Title: Given Name:

Family:

Preferred Name [Badge Details]:

Position:

Organisation:

Postal Address:

State/Country: Post Code:

Business Phone: ( ) Fax: ( )

Email:

Special Requirements: [Dietary or medical]:

I do not wish my address to be included in the delegate list to be distributed at the Conference

REGISTRATION FEES (Inclusive of G.S.T.)

By 10 August After 10 August

Full Member ^ $400.00 $480.00

Non Member $490.00 $570.00

Student $210.00 $210.00

Workshop $100.00 $100.00

Day Registration* $280.00 $280.00

^ Speakers receive 10% discount on this rate or day rate

* Please nominate day of attendance: Friday Saturday

Members Only: If you wish to apply to the Community Health Nurses WA for a country or remote partial re-imbursement of

registration fees please tick the box

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SOCIAL PROGRAMME

Please indicate your intention to attend by ticking (4) the appropriate box. We do require numbers for catering purposes.

Date Event Full Delegate Additional tickets

Thurs 30 August Welcome Cocktails Inclusive $45

Fri 31August Conference Dinner $80 $80

TOTAL $ $

Photos are taken during the conference for the CHNWA website and to promote future conferences. Please tick this box if

you do not give permission for images including you to be used by CHNWA.

PAYMENT SUMMARY

Registration Fees $

Social Programme $

TOTAL $

Please make cheques payable to

Community Health Nurses WA Conference

And forward to:

Peppermint Solutions

PO Box 1000

BUNBURY WA 6231

For EFT payments:

Note: Please email or fax remittance advice if payment made by EFT.

Account: Community Health Nurses Conference

BSB: 036-032

Acc: 29-6840

Westpac

OFFICE USE ONLY

Date: Drawer:

Bank: Branch:

Amount $: Chq No:

EFT Remittance Rcd:

Registration Form

PAG

EN

O. 18


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