1 May - Advanced Skin Course Location-----------Newbolds cnr Frith and Gavey Streets MAYFIELD New South Wales 2304 Australia Venue Phone: (02)49138173 Fill in the form below to register for this event------------------------------------------------------------ Question Title * 1. Contact Details Name: * Email Address: * Phone Number: Question Title * 2. QA# ( if Applicable) Question Title * 3. Do you follow any of the these dietary restrictions? (Please select all that apply.) Vegetarian Gluten Free Food Allergy (please advise below) Food Allergy (please specify) Question Title * 4. Are there any questions you would like to be addressed at this event? Question Title * 5. I require a Certificate of Attendance Yes No ---------------------------------------------------------------------------------------------Fee of $77 applies for Non-membersFee of $44 applies for HPMI members Question Title * 6. Are you currently a member of HPMI? Yes No Not Sure Next
