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ANZPSHG Meeting Registration

ANZPSHG Meeting Registration Form - October 2026

RSVP only if YOU ARE ATTENDING. Email hfaust@haemophilia.org.au if you are not attending.

Name(Required)

Prefix First Last

Organisation / Hospital(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile(Required)

Email(Required)

Please indicate which health professional group you are part of.(Required)

AHNG

ANZHPG

ANZPSHG

Dietary requirements:

A selection of foods will be available for lunch, however please list any allergies, religious or dietary requirements:

Vegetarian

Vegan

Gluten Free

Dairy Free

Dairy & gluten free

Kosher

Other

Dietary Requirement Other (please list):

HFA will fund 1 nights bed/breakfast (in some circumstances 2 nights)

Accommodation Check In Date

Accommodation Check Out Date

Please advise of any special accommodation requirements:

Please include the departure date, preferred time and origin for return flights to Adelaide.

Flight Departure City:

Please indicate your nearest city of departure for flights

Flight Departure Date

Flight Departure Time

:

Name

Please enter your full name as it appears on your ID for flight booking purposes

Prefix First Last

Airline Membership Details:

Frequent Flyer Number or Velocity Details