Registration Form Who: Open to anyone with an interest in comorbidity

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Date	28.05.2018
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6/81 Salamanca Place, Battery Point TAS 7004

Ph: 03 6224 7780; Fax: 03 6224 7800

ABN: 91 912 070 942

Comorbidity Symposium
Working with individuals, families and communities experiencing multiple and diverse needs

Registration Form

Who: Open to anyone with an interest in comorbidity

When: Monday 30 May, 9.15am – 3.30pm (Registrations open at 8.30am)

Where: Hotel Grand Chancellor, 1 Davey Street, Hobart

Cost: FREE

Participant 1 Details: (Please Print)

Given Name Surname

Telephone (BH) (Mobile)

Email contact

Organisation

Address

Participant 2 Details: (Please Print)

Given Name Surname

Telephone (BH) (Mobile)

Email contact

Participant 3 Details: (Please Print)

Given Name Surname

Telephone (BH) (Mobile)

Email contact

Registrations must be received no later than 1 week prior to event

Event may be cancelled if insufficient registrations are received

Registration confirmation email will be sent within 5 working days of ATDC receipt of registration

The organisation may substitute attendees if ATDC is notified before commencement of event

Funded and supported by the Australian Government Department of Health and Ageing under the 'Improved Services for people with Drug and Alcohol problems and

Mental Illness' initiative.

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