CONTINUING EDUCATION REGISTRATION

MEDISCA Australia has prepared a number of high-quality activities to provide you with a unique experience in continuing education, while maintaining an emphasis on quality and integrity.

To register for any of our courses, please fill out the form below and one of our Representatives will contact you shortly to confirm your registration.

Courses

Registrant Information

Add Participants +

Additional Participant Information

Activity Registrant #2

Same as Primary Registrant

Activity Registrant #3

Same as Primary Registrant

Activity Registrant #4

Same as Primary Registrant

Activity Registrant #5

Same as Primary Registrant

As the undersigned pharmacist, I am registering physician(s) to the training activity.
I understand that to receive a certificate, all registrants must complete all relevant competency assessments AND attend the live activity event in full.
I agree to pay for the nominal cost of $395 per physician whom I register herewith, who fails to attend the live event activity in full.

Note : No payment will be due, if the pharmacist provides MEDISCA AUSTRALIA written notice of cancellation of a complimentary physician’s registration, at least fourteen days prior to the live activity event.

Registrant Address

I accept the MEDISCA AUSTRALIA terms and conditions and LP3 terms and conditions*
I hereby give consent to receive electronic communications from MEDISCA AUSTRALIA and its affiliates for marketing purposes.

Confirmation

Please review the information you've provided below. Select the appropriate field to make any necessary corrections. If all information is correct, please scroll to the bottom of this page and click the YES, MY INFORMATION IS CORRECT button to submit your completed registration form.

Courses

Course:
Activity Date / Location:
Number of Participants:

Registrant Information

First Name:
Last Name:
Preferred Name:
Occupation:
Date of Birth:
Member Association:
Pharmacy / Practice Name:
AHPRA Registration Number:
RACGP Registration Number:
Telephone:
Fax:
ABN:
Email:
Dietary Restrictions:

Address

Billing Address:
City:
State / Territory:
Postal Code:
Country:
Shipping Address for
Home Study Workbook:
Additional Comments:

CONTINUING EDUCATION REGISTRATION

Courses

Registrant Information

Additional Participant Information

Activity Registrant #2

Activity Registrant #3

Activity Registrant #4

Activity Registrant #5

Registrant Address

Confirmation

Courses

Registrant Information

Address

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