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VAHPA Training Registration 2017
*
1.
Your details.
(Required.)
First Name
Family Name
Mobile
Non-work Email
Profession
2.
Primary Employer NB. If your primary Employer is other than the Public Sector or Community Health, please select 'other' and enter details in the field below.
Access Health & Community
Albury Wodonga Health
Alexandra District Hospital
Alfred Health
Alpine Health
Austin Health
Bairnsdale Regional Health
Ballarat Health
Ballarat Community Health
Banyule Community Health
Barwon Health
Bass Coast Regional Health
Beaufort & Skipton Health Service
Bellarine Community Health
Benalla Health Service
Bendigo Health
Bendigo Community Health
Bentleigh Bayside Community Health
Carrington Community Health
Calvary Health
Castlemaine Health
Castlemaine District Community Health
Central Bayside Community Health
Central Gippsland Health
Cobaw Community Health
Cobram District Health
CoHealth
Cohuna District Health
Colac Area Health
Darebin Community Health
Dental Health Service
Dianella Community Health
Djerriwarrh Health Service
Dunmunkle Health Service
EACH
East Grampians Health
East Wimmera Health Service
Eastern Health
Echuca Regional Health
Edenhope & District Memorial Hospital
Gateway Health
Gippsland Lakes Community Health
Gippsland Southern Health Service
Goulburn Valley Health
Grampians Community Health
Health Ability
Heathcote Health
Hepburn Health Service
Hesse Rural Health Service
Heywood Rural Health
Inglewood & District Health Service
Inner South Community Health
Inspiro
IPC
Kerang District Health
Kilmore & District Health
Kooweerup Regional Health Service
Kyabram & District Health Service
Kyneton District Health Service
Latrobe Community Health
Latrobe Regional Hospital
Link Community Health
Lorne Community Hospital
Maldon Hospital
Mallee Track Health & Community Service
Mansfield District Hospital
Maryborough District Health Service
Melbourne Health
Mercy Health
Merri Community Health
Mildura Base Hospital
Monash Health
Mayne Health Service
Natalia District Hospital
Nexus Primary Health
Northeast Health Wangaratta
North Richmond Community Health
Northern District Community Health
Northern Health
Numurka District Health Service
Omeo District Health
Orbost Regional Health
Otway Health & Community Service
Peninsula Health
Peter Mac
Plenty Valley Community Health
Portland District Health
Primary Care Connect
Robinvale District Health Service
Rochester & Elmore District Health Service
Royal Children's
RVEEH
Rural Northwest Health
Seymour Health
South Gippsland Hospital
South West Healthcare
St Vincent's
Stawell Regional Health
Sunbury Community Health
Swan Hill District Health
Tallangatta Health Service
Terang & Mortlake Health Service
Timboon & District Health Care Service
Upper Murray Health & Community Services
West Gippsland Healthcare Group
Western Health
Wimmera Health Care Group
Yarram & District Health Service
Yarrawonga District Health Service
Yea & District Memorial Hospital
The Women's
Other (please specify)
3.
Please indicate which of the following VAHPA Delegate Training courses you wish to attend?
Aug 31 & Sep 1
Oct 24 & 25
VAHPA use only
4.
If you are a regional Delegate, which night(s) will you require accommodation for ... (NB If you are unsure at this stage an estimate is ok - we can confirm later on)
The night prior to day 1
The night between days 1 & 2
Both the night before day 1 and the day between days 1 & 2
Neither - I have accommodation in Melbourne
Other (please specify)
5.
Do you have any dietary requirements or restrictions?
No
Yes - Please specify
6.
T-Shirts. Please indicate your preferred t-shirt size for your new Delegate photo
Small
Medium
Large
Extra Large
2XL
3XL
4XL
5XL
7.
Do you have any questions?
8.
Office Use Only
1 - Letter & confirmation emailed
Other (please specify)