Registration Form for the ADS-John R. Turtle Diabetes Clinical Skills Training Course

Title

Given Name

Surname

Are you currently training in Australia or New Zealand? Australia or New Zealand

Current Advanced Trainee Year in Adult Endocrinology Select First Second Third

Name and address of hospital of current advanced training

Postal Address for correspondence

Mobile:

Work Phone

Work Fax

Preferred Email

Name of Principal Endocrinologist
Supervisor:

Do you intend to register for the 2018 ADS/ADEA Australasian Diabetes Congress from 22-24 August? Yes No

From 1:30pm to 2:30pm which Workshop do you wish to attend ?
Workshop A (Problem Solving with BGLs)
or
Workshop B (Advanced Pumping)

From 2:30pm to 3:30pm which Workshop do you wish to attend?
Workshop C (Carbohydrate Counting)
or
Workshop D (Exercise & Diabetes)

From 4:00pm to 5:00pm which Workshop do you wish to attend?

Workshop E (Diabetes in Pregnancy)
or
Workshop F (Fundal Photographs)

or

Workshop G (Management of Dyslipidaemia)

Are you a current member of the ADS? Yes No