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39 TH AASTN NATIONAL CONFERENCE AUSTRALIAN ASSOCIATION OF STOMAL THERAPY NURSES 39 TH NATIONAL CONFERENCE 20–22 MARCH 2013, HOTEL GRAND CHANCELLOR, HOBART 2 0 1 3 a n d B e y o n d D iv ersit y in st o m a, w o u n d a n d co n tinence A U S T R A L I A N A S S O C I A T I O N O F S T O M A L T H E R A P Y N U R S E S I N C REGISTRATION BROCHURE

REGISTRATION BROCHURE - Conference Design Louise Nott Consultant Medical ... been the Director of Aged Care at the Royal Hobart Hospital ... procedures such as hernia repair and appendicectomy

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3 9 T H A A S T N N AT I O N A L C O N F E R E N C EA U S T R A L I A N A S S O C I AT I O N O F S TO M A L T H E R A P Y N U R S E S

39TH NATIONAL CONFERENCE

20–22 MARCH 2013, HOTEL GRAND CHANCELLOR, HOBART

2013 and Beyond – Diversity in stoma, wound and continence

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2013 and Beyond – Diversity in stoma, wound and continence

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Conference HostThis conference is proudly hosted by the Australian

Association of Stomal Therapy Nurses: www.stomaltherapy.com

Conference Secretar iatConference Design Pty Ltd

228 Liverpool Street

Hobart TAS 7000

e [email protected]

w www.cdesign.com.au

p 03 6231 2999

f 03 6231 1522

2013 Conference Venue

Hotel Grand Chancellor, HobartThe Hotel Grand Chancellor overlooks Hobart’s picturesque

and historic harbour, capturing unspoiled panoramic views of

the Derwent River or Mount Wellington and the city. The hotel

provides a restaurant and bar, gym, indoor pool and sauna,

masseuse plus hair salon, art gallery and parking. All rooms have

internet access. The hotel is the home of the Tasmania Symphony

Orchestra which regularly perform in the Federation Concert Hall

adjacent to the hotel.

Who Should Attend?The conference will be relevant to:

• Therapy,ContinenceandWoundCareNurses

• Nurseswithaninterestinstoma,woundandcontinence

• Medicalpractitioners

• Alliedhealthprofessionals

• HealthEducators

• ClinicalLeaders

• ServiceCoordinators

• ClinicalServiceManagers

• AcademicsandResearchers

InvitationIt is with great pleasure that the Stomal Therapy Nurses of

Tasmania invite you to the 39th AASTN National Conference

from 20-22 March, 2013, at the Hotel Grand Chancellor in

Hobart.

Our theme is ‘2013 and Beyond – Diversity in Stoma, Wound

and Continence’.

We look forward to entertaining you in our great State.

Come and experience one of Australia’s best kept secrets –

Tasmania!

Sonia Hicks (Conference Convenor) and the AASTN 2013 Organising Committee

Sponsors

Gold Sponsor Gold Sponsor

Dinner Sponsor Welcome Reception Sponsor

Satchel Sponsor Name Badge Sponsor

Conference CommitteeTracey Beattie, North West Regional Hospital

Teena Carydakis, Launceston General Hospital

Sue Delanty, Launceston General Hospital

Louise Hannan, National Sales & Marketing Manager, Dansac

Margot Hickman, Royal Hobart Hospital

Andrea Hicks, Mersey Community Hospital

Sonia Hicks, Royal Hobart Hospital

Heather Hortle, Royal Hobart Hospital

Carolynne Partridge, Launceston General Hospital

Vanessa Rhodes, Royal Hobart Hospital

Photographic Acknowledgments: Tourism Tasmania.© John de la Roche, Paul Sinclair, Garry Moore, Greg Willson, Geoffrey Lea, George Apostolidis and Southern Cross Television.

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Ms Keryln CarvilleAssociate Professor Domiciliary Nursing

Silver Chain Nursing Association & Curtin University

Dr Penny BlomfieldAssociate Professor

Gynaecologic Oncologist

Invi ted Speakers

Dr Louise Nott Consultant Medical Oncologist,

Royal Hobart Hospital

Dr Louise Nott is a Medical Oncologist at the

Royal Hobart Hospital having completed her

specialty training at the Queen Elizabeth Hospital

in Adelaide. Dr Nott has established a clinical practice treating

most solid organ malignancies with special interests in breast and

colorectal cancers. She is involved in a variety of clinical trials and

has been Principle Investigator on a number of these.

Special research interests have included new ‘targeted’ therapies

for metastatic colorectal cancer; investigation of the anticancer

efficacy of complementary medicines; and vitamin D deficiency/

bone health of cancer patients in Tasmania.

She has also been an advocate for improved cancer care in

regional/rural cancer centres through better access to cancer

clinical trials and Multidisciplinary care in these areas. She plays

an active role in medical oncology education at both a medical

school and Australian fellowship training level.

Mr Michael EeConsultant Paediatric Surgeon,

Royal Hobart Hospital

Mr Michael Ee is a Paediatric Surgeon at

the Royal Hobart Hospital having joined the

establishment in 2010. He was awarded the John Crawford Full

Scholarship to study medicine at The University of Melbourne and

since graduating in 1998, he has travelled, worked and trained in

the United Kingdom, Adelaide and Melbourne prior to completing

his fellowship in Paediatric Surgery.

Michael’s special interest is in the field of neonatal, endoscopic

and corrective surgery. The challenges of introducing new

techniques and skills to Hobart in a safe manner with proven

Keynote Speakers

Mr Duncan ArmstrongBowel Group for Kids Patron

Olympian, television presenter, public speaker,

charity worker – Duncan Armstrong is all these

things and much more.

Duncan approaches everything in life with the same zestful

attitude that helped him win Olympic Gold for Australia. This

approach has also motivated and inspired thousands of people

to achieve their highest corporate and personal goals.

Duncan became a household name at 20 years of age with his

upset win in the 200 freestyle at the Seoul Olympics in 1988.

It was Australia’s 100th Olympic swimming medal.

Since retiring from international swimming Duncan has

enjoyed careers in television and radio, motivational speaking,

endorsements and corporate partnerships.

Duncan has also won a host of honours including Young Australian

of the Year, a Centenary Medal and an Order of Australia Medal.

Dr Jane TolmanDirector of Aged Services

Dr Jane Tolman has worked as a teacher (both

primary and high school), student counsellor,

respiratory physician and geriatrician. She has

been the Director of Aged Care at the Royal Hobart Hospital

since 2006.

Jane was born and educated in Hobart, and attended the University of Tasmania School of Medicine. But until 2006, she worked in urban and regional hospitals in NSW.

Jane is fiercely determined to support the rights of older persons to live independently when this is possible, and to identify dementia when this develops. She would like to see more support for allied health to keep the older person functional at home, but then to assist with dignified palliation as quality and function decline.

She supports the general practitioner as providing the primary care for older persons. She believes that all older persons and their families and carers have the right to information about their condition and the course of their conditions.

Her current goal is to develop a state wide plan for the management of dementia around Tasmania, to support those with dementia, their families and carers, and the providers of their health care. She aims to increase community literacy about dementia by educational programmes and the breaking down of barriers

between the different providers of services to older people.

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Mr Srini YellapuColorectal Surgeon,

Royal Hobart Hospital

Mr Srinivasa Rao (Srini) Yellapu was born and

raised in Visakhapatnam, India. After graduating

in Medicine from Andhra University (1987), he worked at King

George Hospital, Visakhapatnam, Osmania General Hospital,

Hyderabad and All Institute of Medical Sciences (AIIMS), New

Delhi.

Later Srini moved to United Kingdom in 1990 and joined the

surgical training program with College of Surgeons of England,

working at various accredited hospitals in UK. He gained a

Fellowship with College of Surgeons of England (FRCS) in 1993.

Migrating to New Zealand in 1995, Srini continued further

training in a Northern training program based in Auckland. After

completing Advanced training he gained Australasian fellowship in

general surgery in 2003(FRACS). He also carried out two years of

training in colorectal surgery at Addenbrookes Hospital Cambridge

and Bristol Royal Infirmary, Bristol in the UK

Previous specialist appointments include: Locum colorectal

surgeon, Bristol Royal Infirmary, Bristol UK

Consultant surgeon with special interest in colorectal surgery

at Waikato Hospital, Hamilton, New Zealand; and since 2008,

general and colorectal surgeon with admitting rights at Hobart

Private, Calvary and Royal Hobart Hospitals.

Srini’s special interests include minimally invasive colorectal

surgery and trans anal endoscopic surgery.

Mr Carey GallColorectal Surgeon,

Royal Hobart Hospital

Carey Gall is a Colorectal Surgeon based in

Hobart. He trained in Adelaide and Melbourne

and has been working in private practice for over six years. He is

also a visiting surgeon at the Royal Hobart Hospital. His practice

interests are: laparoscopic colorectal resection, colonoscopy,

pelvic floor disorders, incontinence, and surgery for parastomal

hernias. He lives with this wife and son and enjoys collecting (and

drinking) French wine.

benefits continue to motivate him. He is also a keen teacher and

is actively involved with the Royal Australasian College of Surgeons

being an instructor and facilitator in various courses.

Michael’s immediate goal is to further establish and promote a

comprehensive Paediatric Surgical Service to the whole state.

Mr Niall JonesPaediatric Surgeon,

Royal Hobart Hospital

Mr Niall Jones is a consultant Paediatric Surgeon

at the Royal Hobart Hospital since May 2011.

He completed specialist training in Paediatric Surgery after

accredited training in the United Kingdom and Australia in April

2007. He provides laparoscopic (keyhole) gastrointestinal surgery

for children from birth to teenage years. This includes minor

procedures such as hernia repair and appendicectomy as well as

complex procedures such as fundoplication and colectomy. He

was the first Paediatric Surgeon in the UK to undergo fellowship

training in bariatric (obesity) surgery. He has several years’

experience with establishing multidisciplinary weight loss services

for adolescents in the NHS. He has published and presented both

nationally and internationally on the merits of bariatric surgery to

treat obesity in children and thereby improve their quality of life.

Presentation title: Bariatric surgery in adolescents

Ms Margot HickmanRoyal Hobart Hospital

Margot is a Clinical Nurse Consultant (CNC)

in Gastrostomy Care & Enteral Feeding at

Royal Hobart Hospital. While working in the

Endsocopy Unit at RHH in 2001 she identified a need for a more

comprehensive gastrostomy service for patients in Tasmania. By

2005 a recognised position of CNC in Gastrostomy Care was

created at RHH. Weekly clinics are held with a multidisciplinary

approach for Gastrostomy patients. Education has been developed

for Community Health Nurses, schools, patients in the home,

and Aged Care facilities. Margot conducts yearly seminars state-

wide for health care workers and carers. She has also developed

an e-Learning programe on Gastrostomy Care which is easily

accessed on the Internet.

Margot is passionate about continuing care and education to

facilitate improved outcomes for all enterally-fed patients, families

and carers.

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Ms Andrea Miller Clinical Lecturer, University of Tasmania

Andrea is a lecturer with the University of Tasmania. She is

passionate about learning and teaching, in particular supporting

clinical staff who teach students at all levels.

Dr Frank Redwig Urological surgeon, FRACS

DR Frank Redwig has been a consultant urologist at the Royal

Hobart Hospital for more than seven years. Originally born in

Germany and having completed his specialist training in one

of the biggest German Urology units he immigrated to Hobart,

Tasmania with his wife in early 2005.

He helped to introduce and establish minimal invasive

laparoscopic surgery as well as prostate laser therapy within the

Department of Urology at the Royal Hobart Hospital where he was

awarded consultant of the year 2010.

His passion is to provide a comprehensive urological service to

patients and education of junior medical staff at the Royal Hobart

Hospital.

Dr Rajesh Bhatia Trained at The University of Bombay India

Is a Staff Specialist in the Gastroenterology

department at Royal Hobart Hospital for the

past 6 years Has a fellowship in Endoscopic

Ultrasound from Birmingham Alabama U.S.A.

Ms Lisa AstellClinical Nurse Consultant, Continence and Urology, Royal Hobart

Hospital

Lisa began her nursing career in the mid 1980’s at the North-West

Regional Hospital in Burnie. After graduating she went travelling

spending the next 5 years in London, where she discovered her

passion for Urology, specialising at St Peters Hospital, a renowned

Urological Centre.

Returning to Tasmania, she began working at the Royal Hobart

Hospital on the Urology ward and soon discovered her other

passion, teaching. It was not long before she was clinical teaching

and lecturing nursing students for UTAS.

After 9 years of teaching, a Bachelor of Health Science and Master

of Clinical Nursing (Urology) later, she moved into her current role

which is Clinical Nurse Consultant, Continence & Urology. During

this time the service has been expanded and overhauled from a

Continence Nurse Advisor position to offer services to both in and

out-patients across the entire specialty.

Ms Karen CampbellCancer Care Co-ordinator,

Gynaecological Oncology

Karen is a Registered Nurse who practiced as an

accredited Stomal Therapy/Breast Care Nurse

in the North-West of Tasmania for18 years. She moved to Hobart

in 2007 to take up the State-wide position of Cancer care Co-

ordinator Gynaecologic Oncology at the Royal Hobart Hospital

Karen has a keen interest in what effects illness and treatment

has on people’s sexuality and sexual function. She has conducted

sexuality workshops state-wide for patients, carers, nursing,

medical and allied health. Her goal is for sexuality to be seen as

an integral part of care for all people facing health challenges.

Professor Jens J. FroelichProfessor of Radiology and Clinical Professor

of Medicine, Royal Hobart Hospital

Professor Froelich is distinguished Radiologist with more than 20 years of Clinical, academic

and scientific experience, focused on Interventional Radiology and sub-specialised in Neurointerventional Radiology. At present he is Professor of Radiology and Clinical Professor at the University of Tasmania.

Professor Froelich is Fellow of the Cardiovascular and Interventional Radiological Society of Europe, the German Roentgen Society, Member of the European Board of Interventional Radiology, and the Royal Australian and New Zealand College of Radiologists .

He is certified in Health Care Management and has numerous Scientific publications, lectures and awards. Professor Froelich is providing interventional and neuro-interventional services at the Royal Hobart Hospital in Hobart, Tasmania.

Mr Emilio MignanelliRoyal Hobart Hospital

Emilio Mignanelli is a consultant General Surgeon with subspecialty qualifications in Colorectal Surgery. He is a Fellow of the Royal Australasian

College of Surgeons and a member of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). He completed his medical degree at the University of Tasmania and underwent surgical training through the Alfred Hospital in Melbourne as well as Taunton in the United Kingdom. He completed his training as a Clinical Fellow in Colorectal Surgery at the Cleveland Clinic in the USA. His main interest is in laparoscopic surgery for colon and rectal cancer as well as inflammatory bowel disease (IBD). Emilio commenced consultant practice in Hobart in 2009 and is based at the Royal Hobart Hospital and Calvary Hospital.

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Provis ional Program OverviewThis overview is provisional and will be updated as planning proceeds. Times may change in the final program. Please check the website for

the full program and updates regularly.

Wednesday 20 March 20131600-1800 Registration

1730-1830 Welcome Reception Exhibition Area, Hotel Grand Chancellor

Free Evening

Thursday 21 March 20130700 Registration

0800-0820 Opening Session Welcome to County – Leonie Dickson

Delegate Welcome – Sonia Hicks, AASTN 2013 Convenor

Address – Andrea Hicks, President of AASTN Tasmania

0820-0850 Invited Speaker Mr Duncan Armstrong

Bowel Group for Kids Patron

0920-1000 Plenary Speakers

1000-1030 Morning Tea

1030-1200 Concurrent Session A: Novice speakers/Wound

1200-1300 Lunch

1300-1415 Concurrent Session B: Fistulas/The Other Stoma: PEGs

1415-1445 Afternoon Tea

1445-1515 Plenary Speakers

1520-1730 Annual General Meeting

1900 till late Conference Dinner: YESTERDAY, TODAY, TOMORROW

Federation Ballrom, Hotel Grand Chancellor

Entertainment: The Giant Hamsters

Friday 22 March 20130730 Registration

0830-1000 Concurrent Session C: Education/Stoma

1000-1030 Morning Tea

1030-1200 Concurrent Session D: Urology/Stomal Challenges/Sexuality

1200-1300 Lunch

1300-1410 Concurrent Session E: Paediatrics/Bowel Dysfunction Management

1410-1430 Afternoon Tea

1430-1450 AASTN Education and Professional Development Sub-committee

1450-1510 Conference Close

1510-1610 Farewell drinks Exhibition Area, Hotel Grand Chancellor

1610-1700 Conference Committee Meeting for 2015

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Reg istrat ions FeesAll delegates must register individually for the conference.

Early (before 28 January 2013) $550

Standard (after 28 January 2013) $600

Full Registration – Full Time Student $450

Day Registration $300

The student rate is available to full-time students only; please

email a copy of your student card to [email protected]

when you register.

Registration EntitlementsFull Registration

• ConferenceSessionsonalldays

• WelcomeReception

• ConferenceDinner

• MorningTeas

• Lunches

• AfternoonTeas

• ConferenceHandbook

• Satchel

Day Registration

• Sessionsononeday

• MorningTea

• Lunch

• AfternoonTea

• ConferenceHandbook

• Satchel

Payment Pol icyAll payments must be received within 14 days of registering.

Accounts that are not paid before the conference will incur a

$150 processing fee. All accommodation accounts must be

settled on checkout.

Confirmation of Reg istrat ions/ Tax InvoicesA tax invoice/confirmation will be emailed once your registration

has been processed. All prices are quoted in Australian Dollars

(AUD$) and include GST.

Payment Options

Credit Card PaymentsThe conference accepts Visa, MasterCard and American Express.

Payments will appear as ‘Conference Design Pty Ltd’ on your

statement.

Cheque PaymentsPlease send a cheque made payable to ‘Conference Design

(AASTN)’ with a completed registration form or invoice number.

EFT Payments

Please include your invoice number when submitting an EFT

and fax or email Conference Design the EFT details (date,

amount and reference).

BSB: 017 324

Account #: 1085 82575

Account Name: Conference Design (Conference Account)

Bank: ANZ, Sandy Bay Branch

Swift Code: ANZBAU3M

Registration Cancellation PolicyCancellations that are notified in writing 1 December 2012 will

be eligible for a refund less $150. Cancellations notified after

this date will not be eligible for any refund, however another

person may attend the Conference.

Conference Cancellation or PostponementThe members of the Committee and Conference Design Pty Ltd

do not accept any liability for losses incurred in the event of the

conference being cancelled or postponed due to an unforeseen

event or any other event that renders performance of this

conference inadvisable, illegal, impracticable or impossible. An

unforeseen event shall include, but shall not be limited to: an

Act of God; infectious disease outbreak, industrial disruptions,

service provider failures, governmental restrictions and/or

regulations; war or apparent act of war; terrorism or apparent

act of terrorism; disaster; civil disorder, disturbance, and/or riots;

curtailment, suspension, and/or restriction on transportation; or

any other emergency.

In the event the conference is cancelled no refunds will be

issued. All available funds, after cancellation expenses, will

be credited towards a future conference held by the hosting

organisation.

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Social Funct ions

Welcome ReceptionDate: Wednesday 20 March 2013

Time: 1730-1830

Venue: Exhibition Area, Hotel Grand Chancellor

Cost: Inclusive of full registrations

$65 for additional tickets

Dress: Smart Casual

Entertainment: ‘Stolen Moments’ Jazz Musicians

Welcome to AASTN 2013! The Welcome Reception, generously

supported by Coloplast, is an ideal opportunity to catch up with

your interstate colleagues and exhibitors. The reception is also

a great opportunity to meet delegates who are attending the

conference for the first time.

Conference DinnerDate Thursday 21 March 2013

Time 1900 – Late

Venue Federation Concert Hall, Hotel Grand Chancellor

Cost Inclusive of full registrations

$130 for additional tickets

Theme YESTERDAY, TODAY, TOMORROW

Entertainment The Giant Hamsters

Dress After five

Generously supported by dansac, the Conference Dinner will be

held in the magnificent Federation Ballroom at the Hotel Grand

Chancellor. Come dressed in your finery and get ready for a night

of wine, fine food and a fantastic good time! The Organising

Committee for the next conference will outline their vision and

when all the formalities are over, prepare yourself to dance the night

away to the groove and beat of our live band, The Giant Hamsters.

Farewell DrinksDate Friday 22 March 2013

Time Following the close of sessions

Venue Exhibition Area, Hotel Grand Chancellor

Cost Inclusive for all delegates

Join the organising committee for some celebratory farewell drinks

on the mezzanine.

AccommodationRooms have been reserved for delegates at the following hotels

and can be booked when registering. All rates are per room, per

night and do not include breakfast, unless otherwise specified. If

you have any questions or require alternative arrangements please

email Conference Design.

Accommodation BookingsYou will need to provide credit card details when booking

accommodation . Your credit card details will be forwarded to the

hotel to guarantee your booking. In the event of a cancellation

or a ‘no show’ a cancellation fee may be charged to your card

by the hotel. Alternatively, you may pre-pay one night or the

full accommodation amount. Pre-payments must be received

by Conference Design at least 14 days prior to the conference.

Please indicate how much you wish to pre-pay on the registration

form.

Accommodation AccountsYou will need to settle your hotel account, including any incidental

expenses, when checking out. Any pre-payments we receive prior

to the conference will have been forwarded to your hotel.

Accommodation CancellationCancellations must be advised in writing to Conference Design

at least 14 days prior to your arrival. Cancellations received within

14 days of arrival or ‘no-shows’ will attract a penalty of at least

one night’s accommodation.

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Old Woolstore Apartment HotelDistance Two minutes’ walk to the Hotel Grand ChancellorAddress 1 Macquarie Street$189 Hotel Room$209 Studio$239 One-bedroom Apartment$309 Two-bedroom Apartment

The Old Woolstore Apartment Hotel is across the road from the

Hotel Grand Chancellor. It provides restaurant, bar, business

centre, fitness room and internet access. The studio apartments

feature a kitchenette, while the 2-bedroom apartments have full

kitchen and laundry facilities. Some rooms have a small balcony.

Complimentary pass to the pool at the nearby Hobart Aquatic

Centre.

Please visit the accommodation page on the Conference

website for other self-booked alternatives.

For general information regarding the conference and

Hobart, Please see the Conference Website.

www.cdesign.com.au/aastn2013

Hotels and Rates

Hotel Grand ChancellorDistance The Conference VenueAddress 1 Davey Street Hobart$200 Mountain View Standard$235 Harbour View Standard

The Hotel Grand Chancellor overlooks the picturesque and historic

Harbour, capturing unspoiled panoramic views of Derwent River

or Mount Wellington and the city. The hotel provides a restaurant

and bar, gym, indoor pool, and sauna, masseuse plus hair salon,

art gallery and parking. All rooms have internet access. The hotel

is the home of the Tasmania Symphony Orchestra who regularly

perform in the Federation Concert Hall adjacent to the hotel.

Hotel CollinsDistance Five minutes’ walk to the Hotel Grand ChancellorAddress 58 Collins Street$199 Club Room$189 Queen Room$269 One Bedroom Apartment

The Hotels’ elliptical form rises elegantly above its original 1930s

street façade. The result is a building which retains its historical

links but provides a contemporary expression with the Hobart

central business district. Hotel Collins provides a café, bar,

guest laundry and parking is available off-site. All rooms have

complimentary high speed broadband connection and wireless

access is available in the café. The club rooms have access to the

Business Centre. The 2-bedroom apartments have a kitchenette

and lounge.

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Farewell DrinksFriday 22 March 2013

I will be attending ❏ Yes ❏ ❏ No ❏

Accommodation

Hotel Grand Chancellor

❏ $200 Mountain View Standard

❏ $235 Harbour View Standard

Hotel Collins

❏ $199 Club Room

❏ $189 Queen Room

❏ $269 One-Bedroom Apartment Old Woolstore Apartment Hotel

❏ $189 Hotel Room

❏ $209 Studio

❏ $239 One-Bedroom Apartment

❏ $309 Two-Bedroom Apartment

Check in ____ / ____ / 13 ETA: ________________________

Check out ____ / ____ / 13 ETA: ________________________

All accommodation costs are per room per night and are room only.

Accommodation Guarantee

Credit card: The card details will be passed to the hotel as a

guarantee and guests will need to pay on check-out. See the

website for conditions.

Card Type:

❏ Visa ❏ Mastercard ❏ Amex

❏ Use same card listed under payment options

Card Holder: ________________________________________

Card Number: ______________________________________

Expiry Date: ________________________________________

Signature: __________________________________________

Payment Summary

Registration $ ____________________

Social Functions $ ____________________

Total $ ____________________

Title: ________________________________________________

Family Name: ________________________________________

Given Name: _________________________________________

Organisation: _________________________________________

Position:_____________________________________________

Postal Address: _______________________________________

Suburb/Town/City: __________________ State: ___________

Country: _______________________ Postcode:____________

Email Address: _______________________________________

Telephone: (w) _______________________________________

Telephone: (m) ______________________________________

Facsimile: ___________________________________________

Name Badges

Delegate ____________________________________________

Partner (if attending any social functions)

___________________________________________________

Special Requirements

Please advise if you have any special requirements; for example

dietary or mobility

___________________________________________________

Registration Fees

Early (before 28 January 2013) ❏ $550

Standard (after 28 January 2013) ❏ $600

Full Registration – Full Time Student ❏ $450

Day Registration ❏ $300

Social Functions

Please indicate if you wish to attend the following functions.

Registration and Welcome ReceptionWednesday 20 March 2013

I will be attending ❏ Yes ❏ ❏ No ❏Inclusive for full time delegates

Additional tickets ________________ @ 65 = $ _______________

AASTN Conference DinnerThursday 21 March 2013

I will be attending ❏ Yes ❏ ❏ No ❏Inclusive for full time delegates

Additional tickets ________________ @130 = $ _______________

3 9 T H A A S T N N AT I O N A L C O N F E R E N C EA U S T R A L I A N A S S O C I AT I O N O F S TO M A L T H E R A P Y N U R S E S

20–22 MARCH 2013, HOTEL GRAND CHANCELLOR, HOBART REGISTRATION FORM

Payment Options

❏ Cheque (made payable to Conference Design – AASTN 2013)

❏ Credit Card

Card Type: Card Type: Visa ❏ Mastercard ❏ Amex ❏

Card Holder: ________________________________________

Card Number: ______________________________________

Expiry Date: ________________________________________

Signature: __________________________________________

❏ EFT

Date: _________________ Reference: ________________

BSB: 017 324 Account #: 1085 82575Account Name: Conference DesignBank: ANZ, Sandy Bay Branch

Swift Code: ANZBAU3M

Send the completed form to:Conference Design Pty Ltd

228 Liverpool Street

Hobart TAS 7000

T: 03 6231 2999

F: 03 6231 1522

E: [email protected]