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2012 CHCI Annual Meeting Registration Form

If you are a non-CHCI member from Australia who is interested in attending or has been invited by the HRC to attend our program, please use the special registration form linked here. If you are a CHCI member, a presenter, or a guest invited by CHCI, we ask that you please use the registration form below.

Please be sure to total your attendees and fees at the bottom of the form, and remember that a single registration fee of $75US entitles each CHCI member to send up to five delegates to the Annual Meeting (dinner fees are extra, per individual).

Click here to return to the Annual Meeting Information page (form information will automatically save if you wish to return to this page). Please write to us if you have any questions.

Registration Form

Person Filling out this Form
Contact Email
Contact Phone
Organization
University/Host Institution
First Name
Last Name
Title
Email
Dinner
Lodging Selection
Initiative Meeting (13 June 1:30 - 3:30 PM)
Group Meeting (13 June 3:30 - 5:30 PM
Sydney Conference (18-19 June)
First Name
Last Name
Title
Email
Dinner
Lodging Selection
Initiative Meeting (13 June 1:30 - 3:30 PM)
Group Meeting (13 June 3:30 - 5:30 PM)
Sydney Conference (18-19 June)
First Name
Last Name
Title
Email
Dinner
Lodging Selection
Initiative Meetings (13 June 1:30 - 3:30 PM)
Group Meeting (13 June 3:30 - 5:30 PM)
Sydney Conference (18-19 June)
First Name
Last Name
Title
Email
Dinner
Lodging Selection
Initiative Meeting (13 June, 1:30 - 3:30 PM)
Group Meeting (13 June 3:30 - 5:30 PM)
Sydney Conference (18-19 June)
First Name
Last Name
Title
Email
Dinner
Lodging Selection
Intiatitive Meeting (13 June 1:30 - 3:30 PM)
Group Meeting (13 June 3:30 - 5: 30 PM)
Sydney Conference (18-19 June)
Does any attendee listed above have any special dietary needs? If yes, please describe in the field below, and please be sure to indicate the person(s) in your party to whom these instructions apply.
Does any attendee listed above have any special mobility needs? If yes, please describe in the field below, and please be sure to indicate the person(s) in your party to whom these instructions apply.
Notes
Total Number of Attendees
Total Number of Dinners
Total Fee = $75US + $75US per dinner