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FREMANTLE 2001 REGISTRATION
(Please print clearly)

Name ........................................................................... Unit/Organisation ..................................................
Position/ Title ....................................
Member of: HTNA [_].. BNA [_].. UHMS [_].. SPUMS [_].. SAUHMS [_] ..DANSEAP[_] .... please tick
Postal Address .............................................................................................................................................
.....................................................................................................................................................................
Post Code ...............................Country .......................................
Telephone .............................. Fax ........................................ E-mail .........................................................
Accompanying Person's Name ..................................................................................
Full registration for the Scientific Meeting incudes Breakfast and Lunch for Day 2 and 3 and morning and afternoon refreshments for all three days of Conference. The trip to Stirling Naval Base, Submarine Escape Traning Facility covers transport and snacks only. Sessional passes do not include breakfast, lunch or refreshments. Cancellations after the 12th August will incur a 20% cancellation fee.

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REGISTRATION COSTS September 19th - 22th 2001
*Member = HTNA, BNA, UHMS, SPUMS, SAUHMS or DANSEAP member

Sessional passes available to all sessions @ $55 each.
All costs are in Australian Dollars ........................................ GRAND TOTAL AUS$ ________________

METHOD OF PAYMENT - Cash/ Money Order [_] ... Bankcard [_] ... Mastercard [_] ... Visa [_] ... Cheque [_] .... please tick
To pay by cheque, please make cheques payable to: "Hyperbaric Technicians and Nurses Association Inc."

Credit Card # (if applicable) __________________ / ____________________ / ___________________ / ___________________

Name on Card __________________________ Signature ______________________ Expiry Date ______ / ______

Early Registration Prize
All paid registrations received by August 10, 2001 will go into the draw to have their registration for the Annual Scientific Meeting (not the Conference social functions) refunded in full. The winning registrant will be personally notified and then their name will be distributed to all Hyperbaric Units by fax.