Recent Grads Registration Form "*" indicates required fields Δ EmailThis field is for validation purposes and should be left unchanged.PARTICIPANT INFORMATIONFull Name* First Last Email* Phone*Graduation date:* MM slash DD slash YYYY PRACTICE REPRESENTATIVE INFORMATIONPlease note: The Practice Representative should be someone who is directly involved in the participant’s support and development within the practice. Name* First Last Role at Practice :*Phone*Email* PRACTICE INFORMATIONPractice Name*Role at Practice :*Phone*Email* PAYMENT DETAILSI would like to pay the program registration fee of $2,750 inc GST per person using the method specified below.Payment method* EFT/Credit Card Provet Plus Points Paying by Credit Card?I wish to pay an amount of $2,750 inc GST* via EFT/Credit CardInvoice to be made out to :*Paying by Provet Plus Points?I authorise for Provet Plus Points to be deducted from my account for the above program. I have confirmed with my Provet branch that my account has the required points available. Provet Account Number :*ABN :*Authorised by :*Additional CommentsThe information you provide is collected for the purpose of processing your registration and for use in a CCG product or service. It may also be used for the related purpose of keeping you informed of upcoming CCG events and assisting us in improving and marketing our services to you. As part of the arrangement between CCG and supporting companies, CCG will issue each partnering or sponsoring company with the name of all participants and their participating practice and agree to be contacted by the supporting company. By submitting the registration form, your details will be added to the CCG database and used to address specific promotional material to your attention. If you do not wish to receive further information from* YOUR PRIVACY.The information you provide is collected for the purpose of processing your registration and for use in a CCG product or service. It may also be used for the related purpose of keeping you informed of upcoming CCG events and assisting us in improving and marketing our services to you. As part of the arrangement between CCG and supporting companies, CCG will issue each partnering or sponsoring company with the name of all participants and their participating practice and agree to be contacted by the supporting company. By submitting the registration form, your details will be added to the CCG database and used to address specific promotional material to your attention. If you do not wish to receive further information fromCancellations received up to five working days before the event commencement are refundable minus a AU$250 service charge. Cancellations received less than five days prior to the event and non-attendance will be considered as non-refundable.* CANCELLATION POLICY:Cancellations received up to five working days before the event commencement are refundable minus a AU$250 service charge. Cancellations received less than five days prior to the event and non-attendance will be considered as non-refundable.
