The South Australian
Critical Care Ultrasound Course

Registration Form: 20-21st March 2025

All Fields (*) must be completed for acceptance.

Surname :

Firstname :

Preferred Name :

 (on tag)

Mobile / Phone :

Email :

NB:  Server generated emails may be filtered as SPAM.
Please check your SPAM/Junk folder and allow 10-15 minutes for the registration email to appear.

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:

I understand that my position on the course is based upon clearance of payment by EFT and that the order of clearance determines placement.

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

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Online payment through PayPal is available.

Please complete this prior to submitting the above form and check the 'Payment Processed Online' box:

  SA Intensive Care Association