Conference Tickets Form For any inquiries or assistance, please feel free to call or WhatsApp AIMA at 0468 691 676, or email us at admin@aima.org.au AIMA 2025 Conference Registration Form 1Demographic Information2Professional Information3Events Information4Payment Early Bird Tickets Category Description AIMA Member Pricing Non-Member Pricing Cat 1 Specialists, GPs, Dentists $550 $650 Cat 2 Allied Health, JMOs, Pharmacists, Psychologists, Nurses $425 $525 Cat 3 Students $200 $250 Are you an AIMA Member?(Required) Yes - Full Member Yes - Associate Member Yes - Student Member No Upgrade to Full Membership for discounted AIMA Member tickets. Cost: $100/year. Free for students; waived for nurses and allied health (until 31 December 2024). Upgrade here to access member tickets. Join AIMA and become a member to enjoy exclusive benefits! Membership Benefits: Access to WhatsApp groups and newsletters Entry to the Member’s Section Discounted rates on courses and conferences Special pricing for social events Cost: $100/year. Free for students; waived for nurses and allied health (until 31 Dec 2024). Register now by clicking BECOME A MEMBER All membership applications to AIMA undergo a thorough review process to ensure that they meet our membership criteria. AIMA reserves the right to accept or decline any application at our sole discretion.Demographic InformationName(Required) Title DrMissMrMrsMsProf.A/Prof First Last Email(Required) Mobile Phone(Required)Gender(Required) Male Female Address(Required) Street Address Suburb State/Territory Post Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Ticket TypeHiddenMembership Email HiddenTodays Date MM slash DD slash YYYY Members Ticket Type(Required) Student JMO/Allied Health/Pharmacist/Psychologist/Nurse VMO/Specialist/GPs/Dentist Join AIMA and become a member to enjoy exclusive benefits! Membership Benefits: Access to WhatsApp groups and newsletters Entry to the Member’s Section Discounted rates on courses and conferences Special pricing for social events Cost: $100/year. Free for students; waived for nurses and allied health (until 31 Dec 2024). Register now by clicking BECOME A MEMBER All membership applications to AIMA undergo a thorough review process to ensure that they meet our membership criteria. AIMA reserves the right to accept or decline any application at our sole discretion.Become a Full Member! Upgrade your membership here: UPGRADE MEMBERSHIP to access the AIMA members ticket.Your membership as a Full Member is not current. Please renew your membership here to access discounted Member Tickets. Allow 24 hours for processing before purchasing tickets. Not a member? Become a member by registering at BECOME A MEMBERYour membership as a Student is not current. Please contact admin@aima.org.au to access discounted Student Member Tickets. Not a member? Become a member by registering at BECOME A MEMBERNon-Member Ticket Type(Required)Are you an AIMA member? Please enter your membership email address in the 'Email' field to access Member tickets. Student JMO/Allied Health/Pharmacist/Psychologist/Nurse VMO/Specialist/GP/Dentists Subtotal $ 0.00 Education InformationWhat kind of student are you?(Required)Medical StudentNursing StudentDental StudentAllied Health StudentOtherOther(Required) University(Required) Faculty(Required) Course(Required) Year of Study(Required) Professional InformationHealthcare sector(Required)Please SelectMedical PractitionerNursingAllied HealthDentist/OtherMedical Practitioner Speciality(Required)Please SelectAcademicAnesthetistCardiologistDermatologistEmergency Medicine SpecialistEndocrinologistGastroenterologistGeneral Practitioner (GP)Infectious Disease SpecialistNephrologistNeurologistObstetrician and GynecologistOncologistOphthalmologistOrthopedic SurgeonPathologistPediatricianPsychiatristPublic HealthRadiologistRespiratory Medicine SpecialistRheumatologistSurgeonOtherNursing Speciality(Required)Please SelectAged Care NurseClinical Nurse Specialist (CNS)Critical Care NurseEnrolled Nurse (EN)Mental Health NurseMidwifeNurse AnesthetistNurse EducatorNurse Practitioner (NP)Nurse Unit ManagerOncology NursePediatric NursePerioperative NursePublic Health NurseRegistered Nurse (RN)OtherAllied Health Speciality(Required)Please SelectAudiologistChiropractorDental HygienistDental TechnicianDietitianExercise PhysiologistGenetic CounselorOccupational TherapistOrthotist/ProsthetistParamedicPharmacistPhysiotherapistPodiatristPsychologistRadiographerRehabilitation CounselorRespiratory TherapistSocial WorkerSpeech PathologistOtherDentist/Other Speciality(Required)Please SelectDental HygienistDental TechnicianDental TherapistGeneral DentistHealth Information ManagerMedical PhysicistMedical ScientistNuclear Medicine TechnologistOptometristOrthoptistRadiation TherapistOtherOther Speciality(Required) RACGP Membership Number(Required)If you are a member of the RACGP, please enter your membership number below. College NameIf you are a member of a college, please enter the name of the college below. College Membership NumberPlease enter your membership number below. Events InformationDo you have any Dietary Requirements? (Optional)All meals are HalalVegetarianVeganGluten-FreeDairy-FreeNut-FreeHow did you hear about this conference?(Required) Email from AIMA WhatsApp Social Media Website Google Friend/Family Other Gala Dinner - Saturday 19 April 2025 The Gala Dinner is a separate event on Saturday 19 April 2025 at 7:00 PM.Would you like to attend the Gala Dinner?(Required)The Gala Dinner is an additional cost of $100 for conference delegates. It is not included in the conference ticket. Yes Gala Dinner (Additional Cost of $100 per ticket) No Would you like to attend the Gala Dinner?(Required)The Gala Dinner is an additional cost of $80 for conference student delegates. It is not included in the conference ticket. Yes Gala Dinner (Additional Cost of $80 per ticket) No Will you be bringing an additional guest to the Gala Dinner?(Required)Additional Cost of $150. Limited to one guest, must be 18 years or older. Add Gala Dinner Guest ticket (Additional Cost of $150) No Gala Dinner Guest Guest Name(Required)First NameLast NameAny Dietary Requirements?Sub Total Summary & Payment{all_fields}Photography and Videography Notice(Required)By attending this event, I acknowledge that photos and videos may be taken in this public space and shared across AIMA’s platforms, including social media and publications. I have read and understood this statement.Cancellation Policy(Required)Cancellations will be accepted until Wednesday 19 March 2025, with a $55 administration fee (including GST) deducted from all refunds. No refunds will be issued after this date. I have read and understood the cancellation policy.Marketing ConsentI consent to AIMA and its representatives contacting me via email and phone for marketing purposes, including information about this conference, future events, and other updates. I consentConsent to Share Information with SponsorsYour name, email, and phone number will be shared with our sponsors. I consent to my information being shared with sponsors. (Uncheck this box if you do NOT consent.)Sub TotalPayment Processing Fee Price: $ 0.00 Total Ticket IDCredit Card For any inquiries or assistance, please feel free to call or WhatsApp AIMA at 0468 691 676, or email us at admin@aima.org.au
