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Register a Keynote Speaker
Register Form
Organisation nominating this Keynote Speaker at the RHC:
PACASA
RuDASA
RuNurSA
RuReSA
RMHC
Organisation Contact Person:
Contact Person Email:
Delegate registration has been completed:
Yes
No
Name of Speaker:
Please select the SubTheme:
Team Building
Health Systems
Community & Users
Policy & Practice
Rural Mental Health Track
Title of Abstract:
Abstract:
Biosketch not more than ½ page:
Please upload high resolution (Max 2MB) picture of speaker:
Check the photo before uploading: size of file, head & shoulders only, speaker clear against the background
Speakers Email Address:
Expected RHC attendance:
Only for the day of the presentation
The whole conference
Accommodation Required:
Note: a room at the venue will be booked.
Thursday:
Friday:
Saturday:
Travel:
By Car
By Air
Our organisation has informed the speaker that there may be insufficient funds to cover the accommodation & travel arrangements and in this case:
Our organisation will cover the costs
The speaker is willing to cover the costs
The speaker has a sponsor
REGISTER KEYNOTE SPEAKER