CPD Event 2 2012
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Registration form

Pindara Private Hospital is pleased to invite you to attend an education evening to meet our new specialists:
Renal & Hypertension Physician - Dr Mohamed Khafaji;
General Surgeon - Dr John Gault;
and
Urologist - Dr Christopher Tracey.

Time: 6.00pm – 9.00pm
Date: Thursday 23 February 2012
Where: Cypress Room, RACV Royal Pines Resort, Ross Street, Benowa

Program:
6.00pm – 6.30pm Registration
6.50pm Dinner served
7.05pm – 9.05pm Small group discussions
RSVP: Monday 20 February 2012

Application has been made for QI & CPD Category 2 Points (2 point per hour)

*
1. To register please provide the following details:
First name:

To register please provide the following details: First name:

*
2. Surname:

Surname:

*
3. QI & CPD Number:

QI & CPD Number:

*
4. Practice Name:

Practice Name:

*
5. Practice Address:

Practice Address:

*
6. Contact Phone Numbers:

Contact Phone Numbers:

7. Email address:

Email address:

8. Special dietary requirements:

Special dietary requirements:

CPD Event 2 2012Exit this survey

Registration form

*1. To register please provide the following details:First name:

*2. Surname:

*3. QI & CPD Number:

*4. Practice Name:

*5. Practice Address:

*6. Contact Phone Numbers: