Brain Tumour Forum - Brisbane - 11 August 2012Registration of interestWhen: 10 a.m. - 2 p.m. Saturday, 11 August 2012 Where: Auditorium, Cancer Council Queensland Rooms, 553 Gregory Terrace, Fortitude Valley, Brisbane (Opposite the Old Museum).What: A forum based around the visit to Brisbane of Professor Susan M Chang (USA) - one of the world's leading neuro-oncologists. This will be the only opportunity for Australian patients and caregivers to meet with Professor Chang.Enquiries: Catherine Hindson, National Committee Member, Brain Tumour Alliance Australia: catherine@btaa.org.auNote: Please fill in a separate form for each person attending, including partners and family members.You will be contacted by email in due course to confirm your interest. Survey

Brain Tumour Forum - Brisbane - 11 August 2012

Registration of interest

When: 10 a.m. - 2 p.m. Saturday, 11 August 2012

Where: Auditorium, Cancer Council Queensland Rooms, 553 Gregory Terrace, Fortitude Valley, Brisbane (Opposite the Old Museum).

What: A forum based around the visit to Brisbane of Professor Susan M Chang (USA) - one of the world's leading neuro-oncologists. This will be the only opportunity for Australian patients and caregivers to meet with Professor Chang.

Enquiries: Catherine Hindson, National Committee Member, Brain Tumour Alliance Australia: catherine@btaa.org.au

Note: Please fill in a separate form for each person attending, including partners and family members.

You will be contacted by email in due course to confirm your interest.

1. Name

Name Name
Address 1
Address 2
Suburb/City
Postcode
Email Address

2. Telephone

Telephone

3. Category

Category Patient

Caregiver

Family member

Health professional

Member of the public

4. Lunch will be provided. Do you have any special dietary requirements?

Lunch will be provided. Do you have any special dietary requirements?

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