OLYMPUS ENDOSCOPE WORKSHOP 2011

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1 OLYMPUS ENDOSCOPE WORKSHOP 2011 For Nurses and Technicians REGISTRATION FORM

2 2011 Olympus Medical Workshop for Nurses and Technicians CARE AND MAINTENANCE With the increased awareness of the risks associated with cross-infection and inadequately decontaminated medical equipment, the requirement for education and training of staff is vital in running an effi cient unit. Where instrumentation is complex, it is particularly important that those responsible for care and maintenance understand the basic principles of its construction and the possible consequences of not implementing an effective maintenance program. Flexible endoscopes are used in an ever-widening variety of diagnostic and therapeutic techniques. To the uninitiated, these instruments can be awkward to handle with a bewildering array of accessories. So, fully trained staff are essential to the smooth and cost-effective running of a modern operating suite. This intensive program covers care and maintenance, cleaning and disinfection of gastroscopes, colonoscopes, the diagnostic videobronchoscopes and endoscopic accessories. It also covers the history of endoscopy, structure and function of endoscopes and this year will also include surgical products with emphasis on hands on demonstrations for all products. The workshop will be held off site to cater for the growing needs of our environment. REGISTRATION The course fee of $ (inc. GST) per person includes: Course Manual and Materials Hands on Demonstrations with Equipment Meals and Refreshments Certifi cate (issued after completion of the course) Registration / Payment Please complete and return the registration form and payment directly to Rosanne Greene via Fax: and attach the workshop application for Cheque, Visa or Mastercard will be accepted. Cheques payable to Olympus Australia PTY LTD. if paying for more than one attendee please state which workshop date and attendees name. No payments will be accepted on the day of the workshop. Payment must be made with application you are submitting your application to secure your place in the workshop. Please note, in the event of a cancellation, refunds cannot be given. However, a substitute delegate can be nominated (please communicate changes to Rosanne Greene). Registration Enquiries: Rosanne Greene Phone: (02) Fax: (02) rosanne.greene@olympus.com.au

3 2011 NSW WORKSHOP DATES Tuesday 8th March Friday 13th May Wednesday 20th July Monday 12th September Thursday 24th November Registration Time: Workshop Duration: Location: Parking: 8.30 am 9.00 am 4.00 pm The Courtyard by Marriott 7-11 Talavera Road North Ryde, NSW 2113 On-site parking Public Transport: Bus Station - North Ryde (0.5 km E) Train Station - Macquarie Park Station (0.2 km NW) PLEASE BOOK EARLY TO ENSURE YOU GET YOUR DESIRED DATES!

4 2011 APPLICATION FORM Contact Details I / We would like to attend the Olympus Endoscope Workshop for Nurses and Technicians as indicated below. (If this is a group booking, please enter one point of contact below to which all relevant information regarding the workshop will be forwarded to). Please print in CLEAR BLOCK CAPITALS (N.B. Your certificate of attendance and name badge will reflect details provided below). One person per application form. First Name Surname MR / MRS / MISS / MS (please circle) Hospital Department Hospital Address Nurse Educator/contact: Day Time Phone No. Workshop Date Position RN EN Tech Other Olympus Products that you currently work with (please tick) - GI Scopes Surgical EUS / EBUS Cystoscopes Uro/Gyn Bronchoscopes Endotherapy Special dietary requirments: We will be having breakout hands on workshops catering to your requirements. Cost of workshops are $120.00

5 PAYMENT OF FEES: TOTAL AMOUNT PAYABLE: PAYMENT: Payment will be accepted by company cheque and money order or credit card. CREDIT CARD CHEQUE CREDIT CARD: VISA MASTERCARD CARD NO. / / / NAME ON CARD: EXP DATE: / SIGNATURE: CHEQUE/MONEY ORDER: Please make payable to Olympus Australia Pty Ltd and send direct to: Rosanne Greene Administration Assistant Olympus Australia Ground Floor, 82 Waterloo Rd North Ryde NSW 2113 Please return registration forms and attach the workshop application for 2011 to: Att: Rosanne Greene Post: Olympus Australia Ground Floor, 82 Waterloo Rd North Ryde NSW 2113 Fax: rosanne.greene@olympus.com.au Payment will need to be made when submitting your application to secure your place in the workshop. Course attendance is conditional upon advance payment being received. We cannot reserve your attendance if payment is not received when submitting your application. Only payment by cheque or Visa & Mastercard will be accepted and must be sent with a copy of the application form to Janice Sherry in Victoria office. Please note refunds cannot be given in the event of a cancellation within 1 week of the course date. A registered delegate can be substituted for another delegate given notification within 48 hours of the workshop date. Olympus Australia Pty Ltd cannot accept liability in the event of a course having to be cancelled as a result of circumstances beyond its reasonable control. I Agree to the terms & conditions (please tick the box)