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Optometry CPD Night - Brisbane Eye Clinic, Aspley
Tuesday 9th July 2024
Please complete the following registration form.
Optometry Australia QA has been confirmed.
*
1.
Full Name - As per OA registration if applicable.
(Required.)
2.
OA Membership number for CPD time allocation.
*
3.
Provider Number- If multiple locations, include all or the most relevant.
(Required.)
*
4.
Clinic name and location you are practicing at.
(Required.)
*
5.
Email address
(Required.)
*
6.
Mobile Phone Number
(Required.)
7.
Years since graduation
0 - 10
11 - 15
16 - 20
21 - 50
8.
How did you hear about this event?
BEC Relationship Team
Email from BEC
Word of Mouth
Social Media
Other (please specify)
*
9.
Would you like to join our WhatsApp Clinical Optometry portal, to gain access to case studies? If so, please tick yes and we will sign you up.
(Required.)
Yes
No
*
10.
Would you like to receive newsletters, flyers and invitations to CPD events by Mail Chimp?
(Required.)
Yes
No
Maybe
*
11.
What type of delivery do you prefer?
(Required.)
Face to Face
Microsoft Teams, Webex or Zoom
