Event: Dr John Kelly Seminar

Event time: Sun 16 Feb 2014, 10:00a.m.

REGISTRATION FORM and TAX INVOICE

DATES & Course: Dr John Kelly Sunday 16th February 2014

VENUE: Campbell Town – Zeps Cafe

TIME: 10-2pm

COST: Early bird rate (before 1st Dec).

CAA Member-$165                Non CAA Member-$220

After 1st Dec.

CAA member-$220                Non CAA member-$275

4hrs of Formal CPD accredited

Course notes will be forwarded via email once registration is received

Registrations Close: 7th Feb 2014

CUT HERE- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

To pay for your booking, please fill out your details and send to:

CAA TAS Treasurer

99 Forbes Street, Devonport, TAS 7310

Please keep a copy of this form for your records

Name: ________________________________Contact Ph _______________________

Email: ______________________________________________________________________

CAA Member please circle (yes) (no)
Please print CLEARLY – we require email address for registration confirmation


Payment:

( ) DIRECT DEPOSIT A/C name: Chiropractic Association of Australia (Tasmania) Ltd.

            BSB:   632 001  
            A/C no: 1000 18747
            Bank: B&E
            Reference: (use your own name as the reference)

( ) Cheque payment, made payable to Chiropractors Association of Australia, Tasmania, Ltd Send Cheque with registration form to CAA Treasurer 99 Forbes Street, Devonport, Tas 7113

The CAA reserves the right to make any changes or cancellations in the program whenever conditions warrant.

If you need to contact anyone, please call Dr Scott Springer, drscottspringer@hotmail.com