APPLICATION FOR PCFA NURSES ANZUNS CONFERENCE NAME POSTAL ADDRESS CURRENT POSITION WORKPLACE ADDRESS NAME OF CONFERENCE ANZUNS ASM 2015 ATTENDING VENUE Adelaide Convention and Exhibition Centre 3 OBJECTIVES FOR 1. ATTENDING 2. 3. Please submit this form along with proof of residency, proof of registration, your CV and your confirmation letter from your manager that they support your application OFFICE USE Evidence of Australian residency / Yes No □ □ citizenship provided Evidence of nursing registration Yes No □ □ provided Evidence of employer support Yes No □ □ provided Employed in prostate care Yes No □ □ Meets criteria Yes No □ □ Objectives adequately stated Yes No □ □ Successful Yes No □ □ If no specify reason Date response sent to applicant
APPLICATION FOR PCFA NURSES ANZUNS CONFERENCE NAME POSTAL ADDRESS CURRENT POSITION WORKPLACE ADDRESS NAME OF CONFERENCE ATTENDING ANZUNS ASM 2015 VENUE Adelaide Convention and Exhibition Centre 3 OBJECTIVES FOR ATTENDING 1. 2. 3. Please submit this form along with proof of residency, proof of registration, your CV and your confirmation letter from your manager that they support your application OFFICE USE Evidence of Australian residency / citizenship provided Yes □ No □ Evidence of nursing registration provided Yes □ No □ Evidence of employer support provided Yes □ No □ Employed in prostate care Yes □ No □ Meets criteria Yes □ No □ Objectives adequately stated Yes □ No □ Successful Yes □ No □ If no specify reason Date response sent to applicant
pcfa-anzuns-conference-grant-2015-application-form.docx