Registration Form - SHPA CPD - The Society of Hospital

continuing professional development
supporting your lifelong practice as a
current, informed and connected health professional
Short Course in
Assertiveness Techniques
Saturday 12 September 2015 – 9.00 am to 5.00 pm (registration commences at 8.30am) And
Saturday 10 October 2015 – 9.00 am to 5.00 pm (registration commences at 8.30am)
AIM Sydney
7 Macquarie Place, Sydney, NSW
Program at a
Glance
The assertiveness techniques short course will provide participants with personal insight into
the ways in which they respond to different people, situations and events. With a strong focus
on communication and behaviour, it gives participants tools and techniques to effectively
manage their responses and express their views and plans. This course will be held on
two non consecutive Saturdays September 12th and October 10th at AIM Sydney.
If you are an SHPA member and are interested in registering for this workshop, also consider
attending the pre-course webinar on Being assertive without being aggressive (Friday 31st
July from 12.30-1.30pm) where you will learn how to identify aggressive, passive and
assertive behaviours. Participants also learn how they can flex their wording to transform
an aggressive message into an assertive one.
About the facilitator: Nick Mills is a trainer and coach possessing leadership experience
at an operational level as well as experience with internal and external stakeholders across
a wide variety of management disciplines. He has been involved in the business of people
and training for well over 20 years. He is a passionate but commercially savvy facilitator
and coach with a unique skill set covering customer service, leadership, coaching and
communication skills. He has expertise in customer service facilitation and consultancy,
instructional design and facilitation in management and leadership, influencing, presenting,
emotional intelligence and neuroscience.
Pharmacist competency standards*
addressed include:
Learning objectives
1.5 Maintain and extend professional competence
2.1 Communicate effectively
2.3 Collaborate with members of the health care team
2.4 Manage conflict
1. Recognise, monitor and control your behaviour
* National Competency Standards Framework for
Pharmacists in Australia 2010
4. Openly express how you feel
Speaker
Accreditation number:
S2015/19
Registration
Travel and
Accommodation
SHPA Contact
Details
2. Identify when, why and how to respond assertively
3. Demonstrate your assertive rights
Nick Mills - Masters in Adult Communication, University of Technology Sydney, Bachelor of Adult Education,
University of Technology Sydney, Cert IV in Training and Assessment, Cert IV in Business Sales, Cert IV in
Frontline Management, Diploma of Management, Diploma of Neuroscience of Leadership This activity has been accredited for 12 hours of Group 2 CPD (or 24 CPD credits) suitable for inclusion in an
individual pharmacist’s CPD plan).
The registration fee includes tuition, a comprehensive package of course reference materials, lunches and
morning/afternoon teas. Course materials will be forwarded to participants a few weeks prior to the seminar or
on the day.
Participants are requested to make their own arrangements for travel and accommodation AFTER THEY
RECEIVE CONFIRMATION OF A PLACE IN THE COURSE. See overleaf for Registration Form
The Society of Hospital Pharmacists of Australia
ABN 54 004 553 806
Mailing address: PO Box 1774 Collingwood 3066 Victoria Australia Office location: Suite 3, 65 Oxford Street Collingwood 3066 Victoria Australia T: 61 3 9486 0177 F: 61 3 9486 0311 E: [email protected] W: www.shpa.org.au
Assertiveness Techniques Short Course
Saturday 12 September 2015 – 9.00 am to 5.00 pm (registration commences at 8.30am) And
Saturday 10 October 2015 – 9.00 am to 5.00 pm (registration commences at 8.30am)
AIM Sydney
7 Macquarie Place, Sydney, NSW
Name and Contact
Re
ear gister
ens ly to
u
pla re a
ce
Registration Form
Title (Ms/Mr/Dr etc)___________________________________________________________________
Family Name________________________________________________________________________
Given Names________________________________________________________________________
Email Address_______________________________________________________________________
Mailing Address______________________________________________________________________
__________________________________________________________________________________
______________________________________________State__________ Postcode______________
Telephone B/H (
)________________________Facsimile B/H (
)_________________________
Special Dietary Requirements___________________________________________________________
Current Position______________________________________________________________________
Workplace
Employer___________________________________________________________________________
(name of hospital/institution/company/practice etc)
Early Bird Rate Full Rate
(register by 14th August 2015) (after 14th August 2015)
SHPA Members:$1089 (includes GST) $1122.00 (includes GST) 
Non-Members:
$1485 (includes GST) $1518.00 (includes GST) 
Upon payment of your registration fee, this Registration Form becomes a TAX INVOICE
Acknowledgement of registration and a receipt will be forwarded within 6 weeks. If you do not
receive acknowledgement, please contact SHPA.
Registration Fees
Payment Details
TO ENSURE YOUR
PLACE, PAYMENT MUST ACCOMPANY
REGISTRATION
Cancellation Policy
Cancellations received before 6 weeks prior to the event, will receive a full refund minus a handling fee of $50.
Cancellations received between 6 weeks and 1 week prior to the event, will receive an 50% refund of the registration fee.
Cancellations received less than 1 week prior to the event will receive NO REFUND.
Substitutions can be made at any time.
Privacy Policy
If you return this invitation by letter, fax or email, the details will be used to process the invitation. SHPA will not disclose the information to
anyone other than volunteers or contractors who provide services to us or unless compelled or permitted by law to do so. If you want to know
more about our privacy policy and procedures please visit www.shpa.org.au
Cheque enclosed (payable to The Society of Hospital Pharmacists of Australia) 
Please charge my credit card
Visa 
Mastercard 
(please note Diners or Amex not available)
Card No.
Cardholder’s Name: (please print)___________________________________ Expiry Date:___________
Signature:____________________________________________________ Date:__________________
SHPA Contact
Details
Please Mail or Fax Your Registration Form to:
The Society of Hospital Pharmacists of Australia ABN 54 004 553 806
PO Box 1774, Collingwood, Victoria 3066 Australia
Tel: (03) 9486 0177 Fax: (03) 9486 0311 Email: [email protected] Website: www.shpa.org.au