The South Australian
Critical Care Ultrasound Course

Registration Form: 28-29th Aug 2025

All Fields (*) must be completed for acceptance.

Surname :

Firstname :

Preferred Name :

 (on tag)

Mobile / Phone :

Email :

NB: Microsoft (@msn.com, @outlook.com, @hotmail.com, @live.com) addresses get blocked by their email server - so please use an alternate email.
Gmail is OK as are all known Hospital and University email systems.

Hospital :

*State / NZ :

Dietery Requirements :

Emergency Contact :

Contact Mbl/Ph :

Current Position :

Experience Level :

Frequency of use :

Machine Access :

Readily available where you routinely work?

  Brand / Model:

Previous Course :

Have you completed another Echo course?

 

Course Name:

Course Objectives :

Do you have any specific learning objectives?

  List:

PLEASE NOTE:

  • Your position on the course is based upon clearance of payment by:
    • EFT - details provided in registration email, or
    • PayPal - link will appear below when available, and
    • ** the order of clearance determines placement **
  • The Registration eMail may go to your SPAM folder - please check.
  • If you do not receive an email shortly or have other questions, please contact: Course Management

If you wish to pay via PayPal, please process payment (below) prior to submitting this form.   Payment Processed Online.

  SA Intensive Care Association