Advanced Course in Fetal Cardiology 2019

Thank you for your interest in attending the Advanced Course in Fetal Cardiology 2019. To reserve your seat, please fill out the information below.

First Name *

Last Name *

Title

Organization *

Address 1 *

Address 2

City *

State *

Postal Code *

Mobile number *

Email Address *

Include my contact information on lists distributed to other attendees. *

Yes

Days Attending *

Main Session- Both Days- Sat, 22nd & 23rd Feb 2019- $750

Main Session- Sat, 22th Feb 2019 $450

Main Session- Sun, 23rd Feb 2019 $450

Workshop attending *

Workshop- Friday 21st Feb 2019 $100

Not Attending

Activities Attending *

Dinner- Saturday evening- 22nd Feb 2019 - $120

Not attending

Total Due

0.0

Meal Preference *

Special Requirements

Did you attend last years conference? *

Yes

If you attended, what did you most like?

Payment method *

Direct Eftpos transfer- BSB 062212 Account Number: 10548524, Account name Eileithyia Incorporated (Please clearly specify your name on direct debit transection)

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