Register your interest in attending Baxter Home PN Workshop

First Name

Last Name

Would you be interested in attending a face-to-face workshop?

Would you attend a workshop in:

Melbourne

Sydney

Please specify other workshop location you prefer

Which of the following options would you prefer?

Full day session

Two half day sessions

If you prefer two half day sessions, would you be interested in a dinner meeting between the two days?

Please indicate your main patient cohort type

Adult

Paediatric

What topics would you like to see covered during the workshop?

Are there any speakers that you would like to have at the workshop? If so, please specify names/hospitals

Are you interested in presenting at the workshop?

Yes

If you would like to present, please indicate your topic of interest

If the workshop was held in June/July 2024 would you be able to attend? Please specify any dates which you are unavailable during these months if known

Do you have any additional comments

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