Registration

All participants must submit a completed registration form online.

The 1st International LAPAD Conference requires the full data for each individual participant, including updated postal address and email address.

Personal Profile Information

Profile

Please ensure that you enter your name as you would like it to appear on your badge.

Title:

First name:

Last name:

Company / Institution:

Your email address:

Main Address

Please state your main address.

Address Type (Work or Home):

Street:

Suburb / City:

State:

Postal Code:

Country:

Contact Numbers

If you are based outside of Australia, please start numbers with “+” and country code, e.g. +1 23 456 789.

Day Time Telephone Number:

Mobile Telephone Number:

Fax Number:

Emergency Contact Details

This person will only be contacted in the event of an emergency. If your emergency contact person is based outside of Australia, please start the contact telephone number with “+” and country code, e.g. +1 23 456 789.

Name of Contact Person:

Contact Telephone Number:

Please Specify their Relationship to You:

Special Requirements

Do you have any dietary requirements?

Do you have any other special requirements?

Further Information

Where did you hear about the LAPAD conference?

Registration Category

Registration Fees

All fees shown below are in Australian Dollars ($) and include GST.

Which registration category do you require?

Category	Fee	Select
Full Registration	$300
Student Registration	$250
Free Registration (For Speakers)	Free

As a registered delegate of the LAPAD Conference you are entitled to the following:

Registration
All Conference Sessions (for further information see below)
Conference Bag and Program
Morning, Afternoon Teas and Lunches during the conference
Conference Dinner (Friday 30th March at The WA Italian Club)
Transport between the Conference venue and the Conference Dinner venue
Conference 'Sundowner' Barbecue (Saturday 31st March)

Conference Session Attendance

Please indicate which Sessions you plan to attend.

	FRIDAY 30th MARCH – Lifestyle (Diet, Physical and Mental Activity) and AD
	FRIDAY 30th MARCH – Biomarkers of AD and Lifestyle
	FRIDAY 30th MARCH – Poster Session
	FRIDAY 30th MARCH – Hormones and Biomarkers of AD
	FRIDAY 30th MARCH – Conference Dinner
	SATURDAY 31st MARCH – Young Investigator Presentations
	SATURDAY 31st MARCH – Intervention Strategies and AD
	SATURDAY 31st MARCH – Holistic Lifestyle Intervention Designs for Improved Cognitive Function (Debate)
	SATURDAY 31st MARCH – Public Lecture
	SATURDAY 31st MARCH – Conference 'Sundowner' Barbecue

Poster Session

Please state whether you intend to display a poster during the lunchtime Poster Session on Friday 30th March. Please note that if you intend to display a poster you will be asked to submit a poster abstract by 5pm WST on Friday 2nd March 2012.

Do you intend to display a poster?		Yes		No
Are you an Early Career Researcher or a Student?		Yes		No

Young Investigator Presentation Session

If you are an Early Career Researcher or a Student and you submit a Poster Abstract you may be asked to give a 10 minute oral presentation to describe your work in more detail. These presentations will occur during the Young Investigator Session on Saturday 31st March. Please state whether you intend to submit a Poster Abstract and wish your Abstract to be considered for an Oral Presentation to be given during the Young Investigator Session.

I am an Early Career Researcher or a Student and wish my Poster Abstract to be considered for an Oral Presentation to be given during the Young Investigator Session.

Please note that a tax invoice will be issued after payment is authorised.