Autotransfusion Course Multi-Student Corporate Payment

Autotransfusion Course Multi-Student Corporate Payment

The ANZBP Invite all healthcare workers interested in Autotransfusion to enrol in the Autotransfusion Course. The purpose of the course is to provide current and future autotransfusionists with the background information necessary to provide a safe and effective service. The course runs for 10 weeks and is conducted three times per year at a total cost of $450 per student (free to ANZCP full members).

This form is for Hospital/Corporate offline payments for Non-Member Autotransfusion course enrolments only. Please enter the student details here – you can enrol up to 6 students in a single checkout. Please enter your billing details on the next page. Payment details (for direct transfer to the ANZCP bank account) will be emailed to you on completion. Enquiries about your payment status should be emailed to treasurer@anzcp.org.au.

$450.00

Hospital / Employer *

Hospital / Employer Address *

Student 1

Student 1 Name *

Student 1 Email Address *

Student 1 Contact Telephone *

Student 1 Qualifications *

Student 1 Job Title / Position

Student 2

Student 2 Name *

Student 2 Email Address *

Student 2 Contact Telephone *

Student 2 Qualifications *

Student 2 Job Title / Position

Student 3

Student 3 Name *

Student 3 Email Address *

Student 3 Contact Telephone *

Student 3 Qualifications *

Student 3 Job Title / Position

Student 4

Student 4 Name *

Student 4 Email Address *

Student 4 Contact Telephone *

Student 4 Qualifications *

Student 4 Job Title / Position

Student 5

Student 5 Name *

Student 5 Email Address *

Student 5 Contact Telephone *

Student 5 Qualifications *

Student 5 Job Title / Position

Student 6

Student 6 Name *

Student 6 Email Address *

Student 6 Contact Telephone *

Student 6 Qualifications *

Student 6 Job Title / Position

Agreement to Terms

I certify that all details are correct *

I agree to have my details placed on a Register of Students who have completed the ABCP Autotransfusion Course, limited to
a) Name.
b) Qualification/s (i.e. RN, Dip. Anaesth. Tech etc.)
c) Hospital, job title / position and State
d) Month and year of passing the Course *

I acknowledge that although this course provides me with theoretical information, it does not imply clinical proficiency in the practice of autotransfusion or the operation of a Cell Salvage device. *