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Registration B-Referred Re-launch Networking Event (2026)

Thanks for registering to attend the face-to-face B-Referred Re-launch Networking Event.

Thank you for taking the time to fill out the below survey. Providing these details ensures we have an accurate guest count and the catering services are able to meet your dietary constraints or needs.

This is an in-person dinner and the session will not be recorded.

If you want to check the details of this session, please see the registration page by clicking here.
1.What is your first name?(Required.)
2.What is your last name?(Required.)
3.Are you an experienced HBV prescriber? ie. Have you completed the HBV Advanced Management and Prescribing course (prev. HBV s100 prescriber course)?(Required.)
4.Do you have a preferred name you like to be called?
5.What are your pronouns?(Required.)
6.What email address would you like information sent to regarding this course?(Required.)
7.What is your mobile number?(Required.)
8.What is your postcode?(Required.)
9.Do you work in North West Melbourne PHN?(Required.)
10.Are you able to attend in-person at the Venue TBD (North West Melbourne PHN, Melbourne, VIC) on 26 November? As there are limited spaces, please let us know if you are no longer unable to attend.(Required.)
11.Do you have any accessibility requirements the staff should be aware of? Example: ensuring venue entrances and restrooms are wheelchair accessible, etc.
12.Do you have any food allergies that the catering staff need to be aware of? If so, please include your allergies and the level of precaution that needs to be taken.(Required.)
13.Do you have any dietary requirements or preferences?(Required.)
14.By clicking "yes" you understand that full attendance and participation is required. Only participants who attend in full will be issued a statement of attendance.(Required.)
15.By click "yes" you understand that this information will be used by ASHM for demographic purposes and to assist with management of this live session.(Required.)