Title* Name* First Last Address* Suburb* State*SelectAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaOtherPostcode* Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwePhone Fax Email* Preferred Name for Name Badge* Organisation Profession*SelectDoctorNurseParamedicAmbulance ServiceVolunteer first aid workerStudentOtherOther (Please specify) Registration Fees Neonatal Satellite Meeting - 4th May 2017 $295.45 + 10% GST ($29.55) $325.00 SOL Welcoming Cocktail Reception - 4th May 2017 No charge for paying delegate Accompanying Person - (Limit 1 per registration) $50.00 per head Inc GST $50.00 2 Day SOL Conference - 5th & 6th May 2017 Registrations before 26th April 2017 - $590.91 + 10% GST ($59.09) $650.00 Registrations after 26th April 2017 - $636.66 + 10% GST ($63.64) $700.00 Full Time Student - $318.18Copy of student card or supporting letter must be submitted as proof. + 10% GST ($31.82) $350.00 ILCOR Delegate - $454.55 + 10% GST ($45.45) $500.00 ARC ALS Full Instructor - $500.00 + 10% GST ($50.00) $550.00 Conference Dinner - Friday 5th May 2017 $125.45 - Per Head + 10% GST $138.00 Neonatal Satellite Meeting - 4th May 2017SelectAttendingCouncil Member attending Neonatal Satellite Meeting$295.45 + GSTSOL Welcoming Cocktail Reception - 4th May 2017SelectAttendingFree with conference registrationAccompanying PersonSelectAccompanying Person$50.00 Inc GST - (Limit 1 per conference registration) An accompanying person is not eligible to attend the Neonatal Satellite Meeting or the 2 day SOL conference. Accompanying Person DetailsOther Names* Surname* Title* Preferred Name for Name Badge* 2 Day SOL Conference - 5th and 6th May 2017SelectAttendingCouncil Member attending 2 Day ConferenceFull Time Student attending 2 Day ConferenceILCOR Delegate attending 2 Day ConferenceARC - ALS Full Instructor attending 2 Day ConferenceEarly Bird $590.91 + GST | Full Time Students $318.18 + GST | ILCOR Delegate $454.55 + GST | ARC - ALS Full Instructor $500.00 + GSTFull Time Student Evidence*Accepted file types: jpg, jpeg, gif, pdf, Max. file size: 100 MB.Please upload a copy of your student card or other supporting evidence. Allowed file types are jpg, jpeg, gif, pdf. The maximum file size allowed is 64 MBConference Dinner - Friday 5th May 2017 Quantity Price: $ 138.00 Quantity $125.45 + GST Per HeadDietary Requirements Food Allergies Share Your Registration Details? By ticking this box I give the ARC permission to provide my details to the Sponsors and/or exhibitors at the 2017 SOL Conference Total Including GST $ 0.00 Just click on the "Pay with Credit or Debit Card" button Δ