Personal Details

Fields marked * are compulsory.

Personal Details

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(Must be in form dd/mm/yyyy eg 31/01/1970)*

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If  yes please detail your Postrgrad study program and institution.

Specialty Oncology Training

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If Yes please detail your specialty oncology training qualifications and year of completion.

Year of completion :

Year of completion :

If No, please detail your current training program as follows

(eg 2016)

Contact Details

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* (Please provide us with an email address you will be able to access at the Workshop )

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Must be in the format dd/mm/yyyy eg 31/01/1970

Please email a copy of your main passport page to projects2@moga.org.au.

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(The country in which you plan to reside and work)*

Other

Will you require additional assistance or assistive devices to participate in the ACORD Program? (Participants who are visually or hearing impaired, have restrictions on their mobility and may require a personal assistant or assistance equipment, etc..)

Activity Fee

It is compulsory for all participants to pay the registration fee if noted in their letter of offer, in order to complete the registration process by no later than Friday 8 July 2016.