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Thank you for your interest in the Free HICAPS Peter Thurin Seminar.
To RSVP please select one from the following seminars:

Seminar Format
	5.45 - 6.30 pm Network and tradeshow with Drinks and Canapés
	6.30 – 7.30pm Presentation
	7.30 – 8.00pm Network and tradeshow with Drinks and Canapés

Seminar Dates

Brisbane	Tuesday 31 July 2012	Hilton Brisbane Ballroom A & B 190 Elizabeth Street Brisbane, Queensland
Adelaide	Tuesday 7 August 2012	Hilton Adelaide Ballroom A & B 233 Victoria Square Adelaide, South Australia
Perth	Tuesday 14 August 2012	Pan Pacific Perth Golden Ballroom North & Foyer 1 207 Adelaide Terrace Perth, Western Australia
Sydney	Tuesday 28 August 2012	Sofitel Sydney Wentworth Grand Ballroom 61 - 101 Phillip Street, Sydney, New South Wales
Melbourne	Tuesday 4 September 2012	Crown Towers Palladium C & Pre-function area 8 Whiteman Street Southbank, Victoria

Mandatory fields are marked with an *

Practice Details:
Company Name:*
Do you have HICAPS in your practice:*	Yes No
Terminal Number (if applicable):
Contact number:*	(Please include area code)
Email:

The following staff will be attending
	* First Name:	* Surname:
	First Name:	Surname:
	First Name:	Surname:
	First Name:	Surname:
	First Name:	Surname:
	First Name:	Surname:
	First Name:	Surname:
	First Name:	Surname: