2016 members’ Christmas party · 2016 members’ Christmas party Complimentary tickets include:...

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2016 members’ Christmas partyREGISTRATION FORMContact information: please provide details of a current RACGP or AMA(SA) member

Title: ___________ First name: ____________________________________________ Last name: ____________________________________

Organisation: __________________________________________________________ RACGP No./ AMA(SA) no. ________________________

Address: ______________________________________________________________________________ Post code: _____________________

Telephone: ___ - __________________________ Fax number: ___ - ____________________ Mobile number: __________________________

Email: _______________________________________________________________________________________________________

GUEST INFORMATION: Adults TITLE / FIRST NAME / LAST NAME

________/____________________/_____________________

________/____________________/_____________________

________/____________________/_____________________

________/____________________/_____________________

GUEST INFORMATION: ChildrenNAME AGE GENDER (TICK RELEVANT BOX) (CIRCLE ONE)________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL

________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL

________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL

________________ 0-3 yrs , 4-6yrs , 7-12 yrs BOY/GIRL

To register your attendance, please �ll in the registration form and return via email to:sant.events@racgp.org.au, or via fax to 08 8267 8319, or via post to 15 Gover Street, North Adelaide, 5006For queries please contact the faculty of�ce on 08 8267 8310.

PLEASE PRINT CLEARLY

In addition to celebrating the festive season the night will also honour the recipients of the McCleave/Thompson Award.

2016 members’ Christmas party

Complimentary tickets include:

• cocktail food and beverages • door prizes • special appearance by Santa (free photos for children)• children’s entertainment • music and much more!

The RACGP SA&NT in conjunction with AMA(SA) are delighted to invite members and their families to attend the 2016 members’ Christmas party.

Date: Friday 25 November 2016 Time: 6.00–9.00 pmDress: Smart casual Venue: College House, 15 Gover Street, North Adelaide SA Cost: ComplimentaryRSVP: Friday 18 November 2016