FOCUS 3 Registration

FOCUS 3: Management of Patients with Persistent Pain in Regional General Practice

 DATE: 16 October 2010

 TIME: 1.15PM - 5.00PM

 VENUE: Tamworth Community Centre
Cnr Peel and Darling Streets, Tamworth

 RSVP: 11 October 2010

Focus is an educational initiative of
Janssen-Cilag Pty Ltd
ABN 47 000 129 975
1-5 Khartoum Road, Macquarie Park NSW 2113
P. (612) 8875 3333,F. (612) 8875 3300
Generated with MOOJ Proforms
* Required information.
Title *
First Name *
Surname *
Occupation *
General Practitioner
Practice Nurse
Pharmacist
Practice Name
Street No.
Street Name *
Suburb *
State *
Post Code *
Telephone *
Fax
Mobile
Email *
Special Dietary Requirements
Do you want to be sent invitations for FOCUS 4 for your patients to attend an education program on coping with persistent pain? *
Yes
No

 
You will receive a confirmation of your registration. How would you like to receive your registration confirmation? (Please ensure you have provided your email address or fax number in the space provided) *
Via email
Via fax
Via mail

 
A meeting reminder will be sent 3 days prior to the program. How would you like to receive your meeting reminder? (Please ensure you have provided your email address or mobile number in the space provided) *
Via email
Via SMS
Reminder not required

 
Privacy Statement:  At Janssen-Cilag we comply with the National Privacy Principles. We may collect and store your personal information for the purposes of collating responses to the FOCUS program which may include disclosure to Janssen-Cilag affiliates or third parties for the purpose of processing and collating information. This information will be used and disclosed only in accordance with our Privacy Policy and not for any other purpose unless required to do so by law. By registering for FOCUS, you consent to the use of your information in this manner. You may request to access and/or amend your personal information by contacting the Privacy Officer. For our full privacy policy and contact details visit www.janssen-cilag.com.au


,
Client Login



About |Events |Our Work |Our Clients |Privacy Policy |Contact