21st South Pacific Nurses Forum (SPNF) Registration Form
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PART 1: PERSONAL INFORMATION

Title *
Required
Surname
*
First & Middle Name
*
First & Middle Name
*
Age *
Nationality
*
Required
Other Nationality (Write your country down) 
*
Gender *
Required
Contact Phone
*
Email Address
*
Address (in full)
*

PART 2: EMPLOYMENT INFORMATION

Country of Employment
*
Required
Organization Name *
Years of Employment *
Substantive Position *
Years of Service *
Nursing Registration/ license Number *
Current Registration Date
*
MM
/
DD
/
YYYY

Nursing Category

*
Required

PART 3: REGISTRATION FEE (tick in the appropriate box)  

Please note that the registration fee covers the following:

- Emergency Medical Services: Immediate medical response available for emergencies.
- Security: Ensured safety with professional security services throughout the program.
- Meals: Includes morning tea and lunch each day, a welcome dinner on the first evening, and a Gala night celebration to conclude our program.
- Registration Pack: A package containing essential items and information to enhance your experience.
-Transportation: Transport is provided for convenience (Pick up & Drop off) 

Important Exclusions:
- Accommodation and Travel: Please be advised that accommodation, personal expenses, and airfare are not included in the registration fee and will need to be arranged independently.
- Refunds: The registration fee is non-refundable. Payment secures your place at the program, confirming your participation and access to the listed amenities.

By completing your payment, you acknowledge and accept these terms, ensuring a smooth and enjoyable experience. We look forward to welcoming you!
Type of Fee
*
Required
Attendance
*
Required

PART 4: BILLING CREDENTIALS

Account Name:   PNG Nursing Association Inc   

Account Number:  0000224283   

Bank:  Bank South Pacific (BSP)   

Branch: Boroko                                              

Branch BSB Number: 088-943

Swift Code: BOSPPGPM

Account Type: Cheque

Town: Port Moresby                               

Country:  Papua New Guinea

 

NB: All Deposit Receipts must be sent to the email address or phone numbers provided below

PART 5: CONTACT

Phone Number: +675 70776458 / 75493534 (WhatsApp/Call/SMS)

Email: nursingprojectsworkingcompng@gmail.com

Website:  https://www.spnf.org.au/

Facebook Page Name: 21st South Pacific Nurses Forum PNG https://bit.ly/3VPGbiE

Postal Address:

Papua New Guinea Nurses Association

c/- Merilyn Nicholas (Sr)

P O Box 6206

BOROKO

National Capital District, 121

Papua New Guinea

PART 6: DIETARY PREFERENCES 

Please select your current dietary preferences
*
Required
PART 7: MEDICAL BACKGROUND INFORMATION

The information gathered is solely for the purpose of the 2024 South Pacific Nurses Forum and the event medical cover. (N.B For only those who will travel to Port Moresby)

NEXT OF KIN 
(IN THE EVENT OF A MEDICAL EMERGENCY, WHO DO YOU WANT US TO CONTACT? PLEASE WRITE NAME, RELATIONSHIP; HOW HE/SHE IS RELATED TO YOU AND CONTACT DETAILS).
*
ALLERGIES
DO YOU HAVE A KNOWN ALLERGY OR HYPERSENSITIVITY REACTION. FOR EXAMPLE, TO DRUGS/ MEDICINE, FOOD(S), INSECTS/ ANIMALS/ BITES/ STINGS/ POLLEN, FUR, ETC. (CIRCLE YES OR NO). IF YES, PLEASE EXPLAIN BELOW:
*
Required
ALLERGIES
IF YOU ANSWERED YES ABOVE, PLEASE EXPLAIN BELOW:
*
ASTHMA 
ARE YOU KNOWN TO HAVE ASTHMA?
*
Required
ASTHMA 
IF YES, DO YOU HAVE YOUR SUPPLY OF MEDICATIONS?
*
Required
MEDICAL HISTORY

IS THERE ANY PAST OR CURRENT MEDICAL ILLNESSES YOU WOULD LIKE TO DISCLOSE NOW?

*
Required
MEDICAL HISTORY

IF YES, PLEASE WRITE DOWN (E.G. DIABETES)

*
MEDICATION

ARE YOU CURRENTLY ON A PRESCRIBED DRUG/ MEDICATION (MEDICAL TREATMENT)? 

*
Required
MEDICATION

IF YES, PLEASE WRITE BELOW; ALSO, STATE IF MEDICATIONS AVAILABLE. 

*
OTHERS

IS THERE ANY OTHER HEALTH CONDITIONS YOU WOULD WANT TO DECLARE NOW

*
Required
OTHERS

IF YES, PLEASE WRITE BELOW:

*
DECLARATION

The above information is given to the best of my knowledge AND solely for the purpose of the 2024 South Pacific Nurses Forum and medical cover.

*
Required
PART 8: ACCOMMODATION

Further information:

  • For all participating candidates will have to arrange for your own accommodation.
  • Transport will be provided for pick ups and drop off at accommodation site
  • Security Will be provided 24/7

Recommended Hotels for International Participants:

1.       The Stanley Hotel & Suites https://www.booking.com/city/pg/port-moresby

2.       Hilton Port Moresby Hotel Residences https://www.booking.com/city/pg/port-moresby

3.       Grand Papua Hotel https://www.booking.com/city/pg/port-moresby

4.       Ela Beach Hotel https://www.booking.com/city/pg/port-moresby

5.       Holiday Inn Express Port Moresby https://www.booking.com/city/pg/port-moresby

6.       Crown Plaza Residences Hotel https://www.booking.com/city/pg/port-moresby

7.       Lamana Hotel https://www.booking.com/city/pg/port-moresby

8.       The Shady Rest Hotel https://www.booking.com/city/pg/port-moresby


 

Recommended Accommodation for National Participants:

1. Comfort Inn -

2. Citi Boutique Hotel – Citi Serviced Apartments,

3. Edgewood Hotel

5. Paddy’s Hotel and Apartment

6. Wellness Lodge

7. Mahuru Seaview hotel

8. 4mile Inn/Motel

9. Metro Inn

10. Shady Rest Hotel

11. Rain Tree Lodge

12. Metro Inn

13. Granville Motel

14. Aldy Lodge

15. Hohola Apartments

16. Dream Inn

17. Noko Lodge

18. 4mile Inn/Motel

19. Habour view apartments

20. Badili Inn Lodge

21. Lapwing Travelodge

22. Perlease Apartments (Korobosea)

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