Delegate registration information handbook Wednesday 10th – Friday 12th April 2013 Napier War Memorial Conference Centre 48 Marine Parade | Napier | New Zealand

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Table of Contents

Welcome ................................................................................................................................................................. 2

Conference venue ................................................................................................................................................... 3

Recommended accommodation ............................................................................................................................ 3

How the ASM will run ............................................................................................................................................. 3

Key note speakers ................................................................................................................................................... 4

Social Programme ................................................................................................................................................... 5

Scientific Programme .............................................................................................................................................. 5

Full registration tickets ....................................................................................................................................... 8 Day registration tickets ....................................................................................................................................... 8

Workshop Details.................................................................................................................................................... 8

Workshop tickets ................................................................................................................................................ 8 Workshop 1: Training supervisors’ workshop ................................................................................................ 9 Workshop 2: Expert witness workshop .......................................................................................................... 9 Workshop 3: Vaginal prolapse surgery workshop ........................................................................................ 10 Workshop 4: Obstetric Anal Sphincter Injury Surgery (OASIS) Workshop ................................................... 10 Workshop 5: Trainees’ day (Obstetric Medicine), Mock OSCE and dinner .................................................. 10 Workshop 6: Doctors and O&G Day ............................................................................................................. 10

Call for Abstracts (Free Communications) ............................................................................................................ 10

Call for Best Short Cases (Expert Panel) ............................................................................................................... 10

Trade exhibitions .................................................................................................................................................. 11

Internet access ...................................................................................................................................................... 11

How to register ..................................................................................................................................................... 11

Terms and conditions ........................................................................................................................................... 11

Confirmed sponsors and exhibitors ...................................................................................................................... 12

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Welcome Welcome to all participants in the RANZCOG New Zealand Committee ASM 2013. The New Zealand Committee RANZCOG Annual Scientific Meeting in April 2013 is to be staged on the Napier waterfront in Hawke’s Bay. The theme in 2013 is “extreme O&G” and the sessions will gradually progress from scientific updates of core clinical themes towards the rarer and tougher scenarios that we encounter less frequently in practice. We have a great balance of speakers from both the Obstetric and Gynaecology specialties. Experts from other medical disciplines whom we engage and rely on to deliver complete and comprehensive quality care to our patients have also generously given their time. We warmly welcome and thank HOLOGIC as our GOLD sponsor whose assistance in bringing you this exciting conference is greatly appreciated. We are delighted to have Dr Edward Coats as one of our keynote speakers. Ed will set the scene and complement our aims of presenting a dynamic programme. Ed has exposed himself to the extremes in his recent involvement in the 2009 race to the South Pole and also his multiple English Channel swims. He is an inspirational speaker with a medical and law degree to boot, together with a history as a successful decathlete, much of it crammed in and around his UK based training in the O&G specialty. We hope all attendees will leave the conference armed with updated clinical information, new strategies to manage the unexpected, and a re-charged motivation to achieve your in and out of work goals. As well as a packed scientific programme, there are a number of great workshops you can participate in. Book early to ensure your places in the legal expert witness, vaginal prolapse surgery, or obstetric sphincter repair workshops. Further, we are running a “Doctors and O & G Day” which is being programmed in consultation with local GPs to cover topics of high interest. Check this space! Get involved - We want to hear about your case! We want conference attendees to become involved in open discussion and debate in response to the various presentations. To assist the audience to engage with our expert panel about clinical encounters we will present a selection of participants' most extraordinary or extreme clinical vignettes. As part of the registration process we ask you to consider submitting a brief case summary of a case you were involved in. We do mean brief, and as a guide you should anticipate it would be presented in less than 3 minutes, on a maximum of 3 PowerPoint slides. Submission details can be found under Call for Submissions page. We look forward to welcoming you at Hawke's Bay. Yours sincerely,

Dr Craig Skidmore FRANZCOG, RANZCOG NZC ASM 2013 Convenor

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Conference venue Napier War Memorial Conference Centre 48 Marine Parade, Napier 4140, New Zealand http://www.napierwmc.co.nz The conference centre stands right on the beach front of Napier with a spectacular ocean view across the Hawke’s Bay. Only a couple of minutes’ walk from Napier’s beautiful Art Deco CBD, where many attractions, activities, shops and restaurants are situated.

Recommended accommodation Scenic Te Pania Hotel 45 Marine Parade, Napier 4140, New Zealand Tel: +64 6 833 7733 Fax: +64 6 833 7732 http://www.scenichotelgroup.co.nz Hawke's Bay is one of the first places in the world to see the light each day, and Scenic Hotel Te Pania in Napier enjoys a premium waterfront location on Marine Parade. The hotel’s slender curved form echoes the shape of the bay, and guests enjoy sweeping views out over the water. A fresh, contemporary style hotel, Scenic Hotel Te Pania is just a short stroll from Napier’s main art deco style street.

Conference rate: $177.10 per night Booking form is found at the end of this booklet.

How the ASM will run Each day of the conference participants will enjoy: • Talks by the keynote speakers • Lectures on the theme of the session • Lively debate with the experts • Discussions and Q&A sessions • Free communication presentations • Poster presentations • Innovative exhibitor stands The ASM will incorporate topics related to all aspects of basic obstetrics and gynaecology, transitioning through to more extreme scenarios in each of the topic areas.

Please note that all the participants are responsible for booking their own

accommodation.

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Key note speakers Dr Edward Coats

Dr Ed Coats is a Senior Registrar in Obstetrics & Gynaecology currently living and working in Bristol in the United Kingdom. He has first class honours in Human Physiology and a Masters in the Legal Aspects of Medical Practice. Ed was awarded the ‘Osler Medal’ by the Worshipful Society of Apothecaries in London, whilst undertaking his Diploma studies in The History of Medicine. Ed is a former Great Britain track and field decathlete having competed internationally for several years and as an accomplished swimmer he has led two teams to swim the English Channel. In 2009 Ed took a short break from medicine to take part in the first ever race to the South Pole. He completed a two-day selection course to win his place on the expedition team beating over 650 applicants. Six teams from around the world took part in what has been billed as the toughest endurance race on the planet. The team skied 500 miles unsupported across Antarctica for 16 hours a day in temperatures as low as minus 50 degrees Celsius, while pulling 80kg sleds behind them. Ed has also recently returned from an expedition to the North Pole and is no stranger to extreme environments.

Professor Ajay Rane Professor Ajay Rane is the Vice President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). He is currently the Head of Obstetrics and Gynaecology at James Cook University in Townsville, Queensland, Australia and Director of Urogynaecology at Townsville Hospital and VMO at Mater Hospital in Townsville. Recognised for his dedication and commitment to improving the pelvic health of women and recognised globally for his contribution to urogynaecology, Professor Rane was a State Finalist of the Queensland Australian of the Year 2012. He has been comprehensively involved with the College for over 15 years, holding such positions as Councillor, Treasurer, Member of the RANZCOG Board, Member of the Education and Assessment Committee, Member of Training Accreditation Committee and Chair of the Conjoint Committee for the Diploma of Obstetrics and Gynaecology (CCDOG). Professor Rane is also a member of the Asia Pacific Committee of RANZCOG, and has been a training supervisor, subspecialty trainer and Chair of Basic Surgical Skills at the College.

Session speakers: Dr Selwan Al-Salihi, Dr Angela Craig, Dr Katie Groom, Dr Keith Harrison, Dr Lesley Hayward, Dr Jenny Hayward, Dr Simon Kelly, Dr Andrew Murray, Dr Digby Ngan Kee, Dr Rosemary Reid, Dr Stephen Robertson, Dr Bryony Simcock, Dr Sarah Wakeman, Dr Lucille Wilkinson

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Social Programme

Wednesday 10 April 6 pm – 8pm

Welcome Function Exhibition hall, Napier War Memorial Conference Centre The welcome function is an opportunity to meet your fellow participants over canapés and bubbly whilst visiting the trade exhibitors. $60 per person (GST included) Included in the Full Registration Ticket only.

Thursday 11 April 6.30 pm – 8.30 pm

Social Event: Visit to the National Aquarium of New Zealand National Aquarium, Napier New Zealand's largest display of aquatic life and unique New Zealand wildlife, including sharks, stingrays, living coral, kiwi, tuatara and a huge range of fish species. Also a great opportunity to network with your fellow participants and their families. Come and join us over drinks and a light meal! http://www.nationalaquarium.co.nz/spiritual-connection.asp $92 per person (GST included) * NOT INCLUDED in the Full Registration Ticket.

Friday 12 April 7.30 pm – 10pm

HOLOGIC Conference Dinner and ASM closing ceremony Craggy Range Vineyard, Havelock North

$155.25 per person (GST included) Included in the Full Registration Ticket only.

Saturday 13 April

Golf round at Cape Kidnappers [post ASM social event] A fun round with Dr Jeremy Meats at Cape Kidnappers Golf Course .

$300 per person (GST included) * NOT INCLUDED in the Full Registration Ticket.

Scientific Programme Wednesday 10 April 2013

Wednesday 10 April 5pm – 6pm

Opening session Ballroom, Napier War Memorial Conference Centre

• Maori welcome • Opening words from the President • New Zealand updates - Mr John Tait, Chair, New Zealand Committee • Introduction of the guest speaker - Dr Craig Skidmore, ASM 2013 Convenor • Talk by Dr Edward Coats, Southmead Hospital, UK

Wednesday 10 April 6pm – 8 pm

Welcome function Exhibition Hall, Napier War Memorial Conference Centre Come join us and catch up with your friends and fellow colleagues over drinks and nibbles!

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Thursday 11 April 2013

Session 1

Obstetrics – the shocked patient Ballroom, Napier War Memorial Conference Centre 9.00 am Clinical session - Dr Ed Coats 9.20 am The Shocked Fetus - Dr Katie Groom 9.40 am ICU approach to obstetric patient shocked antenatal and postnatal 10.00 am Panel debate with the experts* * Calling for your extreme cases for the expert panels! See Call for Abstracts page for further information.

Break 10.30 am Morning Tea and Trade Exhibition Exhibition Hall, Napier War Memorial Conference Centre

Session 2

Reproductive medicine - meet the makers Ballroom, Napier War Memorial Conference Centre 11.00 am Ovulation induction, when to go and when to stop - Dr Andrew Murray 11.20 am Assessing the genome within: fetal genetic diagnosis for today and tomorrow

Dr Stephen Robertson 11.40 am Extremes of IVF - Dr Sarah Wakeman 12.00 pm IVM and egg cyropreservation - Dr Simon Kelly 12.20 pm General Question and Answer

Break 12.30 pm Lunch Exhibition Hall, Napier War Memorial Conference Centre

Session 3 Free communications – Obstetrics Ballroom, Napier War Memorial Conference Centre See Call for Abstracts page for further information.

Session 4

Mesh - OMG Ballroom, Napier War Memorial Conference Centre 3.30 pm Vaginal mesh update - should we be doing it? Oh the Politics!

- Dr Lynsey Hayward 3.50 pm Apical solutions - Dr Lynsey Hayward 4.10 pm Voiding dysfunction in Anterior Wall Prolapse - including managing post

op voiding dysfunction - Professor Ajay Rane 4.30 pm Anterior vaginal procedures - Professor Ajay Rane 4.40 pm Posterior vaginal repair options procedure - Dr Salwyn Al-Salihi 4.50 pm Questions

Special session

Multiple births – panel discussion Ballroom, Napier War Memorial Conference Centre RANZCOG New Zealand and New Zealand Multiple Birth Association invite you to join the panel discussion about current issues in multiple births pregnancy. The panel will include representatives from RANZCOG, New Zealand College of Midwives, New Zealand Multiple Birth Association, and Ministry of Health.

Social event Visit to the National Aquarium 7pm – 8.30 pm

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Friday 12 April 2013

Session 5

Extreme odds and ends Ballroom, Napier War Memorial Conference Centre 9.00 am Sexual assault - who to call, what to do and not do, reports/court

- Dr Jenny Hayward 9.20 am Genetic cancer causes, evolving genetics, and screening for gynae malignancy

- Dr Bryony Simcock 9.40 am A new Hep B approach in obstetrics, update - Dr Lucille Wilkinson 10.00 am Expert Session: tricky surgical scenarios

Break 10.30 am Morning Tea and Trade Exhibition Exhibition Hall, Napier War Memorial Conference Centre

Session 6

High Risk Obstetrics Ballroom, Napier War Memorial Conference Centre 11.00 am Life threatening medical conditions in pregnancy: Hearts and Brains

- Dr Lucille Wilkinson 11.30 am Preterm labour: Are we winning? - Dr Rosemary Reid 11.50 am Preterm delivery: Your place or mine? - Dr Angela Craig 12.10 pm Expert Panel - case presentation * * Calling for your extreme cases for the expert panels! See Call for Abstracts page for further information.

Break 12.30 pm Lunch Exhibition Hall, Napier War Memorial Conference Centre

Session 7

Free communications – Obstetrics Ballroom, Napier War Memorial Conference Centre See Call for Abstracts page for further information.

Session 8

Extreme Top and Bottom Ballroom, Napier War Memorial Conference Centre 3.30 pm Dangerous laparoscopy - Dr Digby Ngan Kee 3.50 pm They keep getting bigger - Dr Keith Harrison 4.10 pm Obstetric trauma OMG - Professor Ajay Rane 4.30 pm Expert Session

Special Session

Mercia Barnes Trust Ballroom, Napier War Memorial Conference Centre Presenters to be announced. Come and find out more about what the trust does and hear some presentations from the past projects.

Conference dinner

HOLOGIC conference dinner and ASM closing ceremony Craggy Range Vineyard Included in the full registration ticket.

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Full registration tickets Early Bird

(until 14 February 2013) Standard (from 15 February 2013)

Fellow / O&G IMG $1,023.50 $1,150 Other $690 $828

• One ticket to the opening session and welcome function on 10 April. • Participation to the ASM Scientific Programme, morning/afternoon tea and lunches for 11 - 12 April. • One ticket to the conference dinner at Craggy Range. • A delegate bag (name badge, handbook and pocket programme, list of participants, trade exhibition

passport). • Access to exhibition booths. • Opportunity to purchase a ticket to attend the networking event: “Visit to the National Aquarium” on 11

April. Day registration tickets

Early Bird (until 14 February 2013)

Standard (from 15 February 2013)

Fellow / O&G IMG $517.50 $609.50 Other $391 $471.50

• Participation to the ASM Scientific Programme of your choice (11 or 12 April), morning/afternoon tea and lunches for that day.

• Conference Dinner at Craggy Range • Name badge, pocket programme and list of participants. • Access to exhibition booths. • Opportunities to purchase the social event ticket “Visit to the National Aquarium” and “Hologic

conference dinner and ASM closing ceremony” ticket at Craggy Range for networking.

Workshop Details Workshop tickets

Workshop 1 Training supervisors’ workshop Tues 9 April, 9am – 5pm, Napier War Memorial Conference Centre

Free for RANZCOG Fellows

Workshop 2 Expert Witness Workshop Wed 10 April 9am – 5pm, Napier War Memorial Conference Centre, $920

Workshop 3 Vaginal Prolapse Surgery Wed 10 April 9am – 1 pm, Royston Hospital $400

Workshop 4 Obstetric Anal Sphincter Injury Surgery (OASIS) Workshop Wed 10 April 9am – 1 pm, Napier War Memorial Conference Centre $1000.50

Workshop 5 Trainees’ Day (Obstetrics Medicine), Mock OSCE and Dinner Wed 10 April 9am – 4pm, 7 pm – 9 pm Venue to be announced.

$540.50

Workshop 6 Doctors and O&G Day Sat 12 April 9am – 12 pm, Napier War Memorial Conference Centre.

$210

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Workshop 1: Training supervisors’ workshop Date and time: Tuesday 9 April, 9am – 5pm Venue: Breakout room, Napier War Memorial Conference Centre Limit: 20 Fellows CPD meeting points: To be advised This one-day workshop facilitated by College House is for new and experienced ITP/Elective and Subspecialty Training Supervisors and focuses on the supervisory role. Participants will look at the practicalities of training, including:

• The learning objectives of assessment requirements of the RANZCOG Curriculum • CLIMATE, the College’s new eLearning platform for trainees and Fellows • Formal and informal ways of giving constructive feedback • Helping underperforming trainees • RANZCOG training documentation and using it correctly (e.g. 3-mthly & 6-mthly assessments)

The workshop is interactive and includes discussions, videos and role plays. The trainers will also update you on the recent changes on training guidelines.

Workshop 2: Expert witness workshop Date and time: Wednesday 10 April, 9am – 5pm Venue: Breakout room, Napier War Memorial Conference Centre Facilitator: Jonathan Coates Limit: 20 CPD meeting points: To be advised • Overview of the role and duties of an expert witness • History and definitions • Codes of conduct - what are your obligations professionally & to the court/tribunal? • Pitfalls - conflicting expert evidence, hindsight bias, immunity • Expert appointment • Are you an expert and what is the scope of your expertise? • When should you refuse to act as an expert? • What specific instructions should you require? • Terms of your appointment - what should you expect and require? • Break-out session – case studies – identifying issues and knowing how to respond; practical examples

including conflicts of interest, scope of expertise, letters of instruction, terms of appointment • Report writing • Key requirements • Model forms of expert reports • Confidentiality and litigation privilege • Sharing of reports with the “other side” • Break-out session - critiquing expert reports - practical examples of expert reports • Understanding court systems and presenting evidence effectively • An overview of the litigation process • Appointment of court expert(s) and powers of the court to direct expert witnesses (conferencing; joint

statements; hot tubbing) • Preparing for a hearing - what do you need to do? • Court etiquette and rules of evidence - what you can and can’t say and do • The process of presenting evidence and questioning (examination in chief, cross examination, and re-

examination) - good techniques • Practical demonstration - court simulations - act as an expert witness, present your evidence and be cross-

examined?

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Workshop 3: Vaginal prolapse surgery workshop Date and time: Wednesday 10 April, 9am – 1 pm Venue: Educational conference room, Royston Hospital Limit: 20 CPD meeting points: To be advised Presentations on each compartment focussing on - anatomy of pelvic supporting structures, pathophysiology of prolapse in each compartment, clinical features of prolapse, surgical options for prolapse repair in each compartment including mesh and native tissue repair. Also covering tips and tricks for surgery.

• Professor Ajay Rane - Anterior compartment • Dr Lynsey Hayward - Vaginal apex • Dr Salwyn Al Salihi - Posterior compartment

If there are any changes to the plan, the registrants will be informed in advance. Workshop 4: Obstetric Anal Sphincter Injury Surgery (OASIS) Workshop Date and time: Wednesday 10 April, 11am – 4pm Venue: Ballroom, Napier War Memorial Conference Centre Limit: 20 CPD meeting points: 5 PCRM points OASIS (previously known as third and fourth degree tears) Workshop is aimed at Obstetricians and General O&G Specialists who wish to update their skills and acquire 5 PCRM points from RANZCOG. The workshop involves up to date information about risk factors, identification, suturing techniques, management of subsequent pregnancy and follow up. This is followed by a 'hands on' session with latex models and pig anal sphincter to practice repair techniques. It is fun and interactive and useful for your clinical practice. Workshop 5: Trainees’ day (Obstetric Medicine), Mock OSCE and dinner Date: Wednesday 10 April 2013 Time and venue: all day (further details to be announced soon) Limit: 20 The Trainees’ day workshop will focus on “Obstetric Medicine”. Further programmes will follow soon. Workshop 6: Doctors and O&G Day Date and time: Saturday 13 April, 9am – 12pm Venue: Breakout room, Napier War Memorial Conference Centre CPD meeting points: To be advised

Call for Abstracts (Free Communications) You are invited to submit your abstracts to be selected for the free communication session. For more details, please visit the registration website . The applicants who were not successful may be offered an opportunity to present in poster format. The secretariat will be in touch when the decisions are made.

Call for Best Short Cases (Expert Panel) We would like you to become involved in open discussion and debate in response to the various presentations. To kick start the discussion with the expert panel, we are calling for your extraordinary or extreme clinical cases to share with us. When you register, please consider submitting your brief case summary. To secure enough time for the discussion and debate with the expert panel, we ask you to

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make it brief, less than three minutes within three PowerPoint slides. Further details can be found from our website.

Trade exhibitions The Trade Exhibition will be open in the Exhibition Hall at Napier War Memorial Conference Centre.

• Wednesday 10 April - 6.00 pm to 8.00 pm (during the welcome function) • Thursday 11 and Friday 12 April - 8.00 am to 6.00 pm A Trade Exhibition Passport will be made available to each delegate at registration. Passports which have been endorsed by all exhibitors will be entered into a draw for a major prize with the winner announced at the conference dinner.

Internet access We are pleased to inform you that you will be able to enjoy the free wireless internet offered by the Napier War Memorial Conference Centre.

How to register Please complete the registration form enclosed at the end of this handbook.

Terms and conditions Refund and Cancellation Policy:

• Notice of cancellations should be submitted in writing to the RANZCOG NZ Office Event Officer. • A refund of 90% of the registration fee will be made for cancellations received on or prior to 10

March 2013. • A refund of 50% of the registration fee will be made for cancellations received on or after 10 March

2013 before 31 March 2013. • No refund will be paid on or after 1 April 2013, and for failure to attend without notice. • When there are extenuating circumstances, a full refund of the registration fee may be considered by

and at the discretion of the Organising Committee. Name on Statement: The name "RANZCOG College" will appear on the cardholder statements for any transactions through the registration website. Service Delivery: Refer to the Programme page for details (https://wired.ivvy.com/event/NZ2013/). Accommodation: • Participants are requested to arrange their own travel and accommodation. • If you wish to book Scenic Hotel Te Pania, registration form can be downloaded from the Accommodation page (https://wired.ivvy.com/event/NZ2013/). For their cancellation policies please contact the staff at the hotel.

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Confirmed sponsors and exhibitors Sponsors

GOLD Sponsor

Exhibitors GE Healthcare Intermed Medical Pharmaco (NZ) Ltd We look forward to seeing you at the ASM. If you have any questions, feel free to contact the secretariat. New Zealand Committee Annual Scientific Meeting Organising Committee 2013 Dr Craig Skidmore …….. Convenor Dr Lynda Croft …………… Committee Member Dr Jeremy Meates …….. Committee Member Dr Keith Harrison……..… Advisor to the Committee

Secretariat – RANZCOG New Zealand Office Ms Jane Cumming, Executive Officer Ms Makiko Wimbush, Event Officer Ms Jude Kaveney, Training Co-ordinator

For more information contact the ASM secretariat. RANZCOG New Zealand Committee | PO Box 10611 | The Terrace | Wellington 6143 Tel: +64 4 472 4608 | Fax: +64 4 472 4609 | asm2013@ranzcog.org.nz

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists New Zealand Committee Annual Scientific Meeting 2013

10 – 12 April 2013 at Hawke’s Bay l War Memorial Conference Centre Napier

Registration Form 1. DELEGATE DETAILS Professor Dr Mr Mrs Ms Other ( )

Surname Given name Preferred name for name badge (if different from above)

Postal address:

Telephone: Home / Office Mobile:

Email:

Name of Hospital/Private Practice (for name tag):

Dietary requirements:

Please select which applies to you

RANZCOG Fellow / O&G IMG RANZCOG Registrar Midwife General Practitioner

Anaesthetist Radiologist Other ( )

2. PRIVACY I AGREE to my information being included in the participant list distributed to delegates and exhibitors at the meeting. I AGREE to have my name and email address distributed to the delegates to meet up for networking purposes.

3. MEETING REGISTRATION

Full Registration Early bird Until 14 February

Standard After 15 February

Full registration- RANZCOG Fellow I O&G IMG $1,023.50 $1,150

Full registration - Other $690 $828

• Full Registration includes attendance at all ASM Sessions, daily morning tea, lunch and afternoon tea (if served), Open ing Sess ion , Welcome Function and Conference Dinner. It DOES NOT include the Social Event or any Pre & Post ASM Workshops.

Day Registration Early bird Until 14 February

Standard After 15 February

Day registration - RANZCOG Fellow I O&G IMG $517.50 per day $609.50 per day

Day registration - Other $391 per day $471.50 per day

Please indicate the day(s) of attendance Thurs 11 April Fri 12 April

• Day Registration includes attendance at all ASM sessions, morning tea, lunch and afternoon tea (if served) on the day of registration. No evening functions are included and must be purchased separately.

Subtotal of meeting registration (A) $

Registration Form Continues Overleaf

3. PRE & POST ASM WORKSHOPS REGISTRATION (all incl GST)

Training Supervisors Workshop for RANZCOG Fellows - Tuesday 9 April Free Expert Witness Workshop – Wednesday 10 April $920 Trainees’ Day (including Dinner) - Wednesday 10 April ( Also attending dinner) $540.50 Vaginal Prolapse Surgery – Wednesday 1 0 A p r i l $400 Obstetric Anal Sphincter Injury Surgery (OASIS) – Wednesday 10 April $1,000.50 Doctors and O&G Day – Saturday 13 April $210

Subtotal of workshop registrations (B) $

4. Social Functions (all incl GST)

Opening Session and Welcome Function (Wednesday 10 April) Number of tickets ( ) x $60 Total $ Social event “Visit to the National Aquarium” (Thursday 11 April) Number of tickets ( ) x $92 Total $ HOLOGIC Conference Dinner (Friday 12 April) Number of tickets ( ) x $155.25 Total $ Golf at the Cape Kidnappers (Saturday 13 April) Number of tickets ( ) x $300 Total $

Subtotal of social functions (C) $

Name(s) Badge for Additional Tickets (e.g. partners or g uests) for above

Surname Given name

Surname Given name

5. GRAND TOTAL

(A) Meeting Registration (page 1) $

(B) Pre & Post ASM Workshops (page 2) $

(C) Social Functions (page 2) $

Grand total $

6. PAYMENT DETAILS

Cheque (Please make cheques payment to 'RANZCOG')

Credit Card Visa Mastercard

Cardholder's Name: Card Expiry: I

Card Number: Amount: $NZ ---------inc. GST Signature: -----------------

Cancellations (valid only in writing) received prior to 28 February 2013 will be entitled to a refund less an administrative fee of $150. Cancellations received after 1 March 2013 will not be entitled to refund. ALL AMOUNTS INCLUDE 15% GST

Please send this form to the ASM Secretariat: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, New Zealand RANZCOG New Zealand Office | PO Box 10611 | Wellington 6143 t: +64 4 472 4608 | f: +64 4 472 4609 | email: asm2013@ranzcog.org.nz

TAX Registered

Royal Australian &NZ College of Obstetricians/ Gyne Conference Booking Number: 13190877

ACCOMMODATION FORM: 8th April 2013 – 14

th April 2013

HOTEL BOOKINGS AT THE SCENIC HOTEL TE PANIA

45 Marine Parade, Napier

NAME: (Title & Initials)__________________________________________________

ADDRESS:___________________________________________________________

PHONE: ( ) _________________________________ FAX: ( ) _______________________

E-MAIL:___________________________________MOBILE: ___________________

ARRIVAL DATE:_______________________ARRIVAL TIME:_________2pm___________

DEPARTURE DATE:__________________DEPARTURE TIME:____________10am________

NUMBER OF GUESTS OCCUPYING THE ROOM:________________________________

ROOM REQUIREMENTS: (Please Circle)

SINGLE / TWIN / DOUBLE

ROOM RATES: Standard $177.10 incl GST per room, per night

Check-in time is no earlier than 2.00pm; non guaranteed bookings will be cancelled at 6.00pm on the day of

arrival

METHOD OF PAYMENT: (Please Circle) CASH / EFTPOS / CREDIT CARD

PLEASE GUARANTEE MY BOOKING WITH THE CREDIT CARD NUMBER LISTED BELOW:

Please Circle: AMEX MASTERCARD VISA DINERS

CARD NUMBER:______________________________________ EXP DATE:_______________

SIGNATURE: _________________________ DATE:___________________

Conference accommodation conditions:

Cancellation policy: if you wish to cancel your reservation, please notify the hotel at least 24 hours prior to the date of arrival. Cancellation fees may apply.

Any guest, whom fails to check-in and has not advised us of a cancellation, will be subject to one nights accommodation charge.

More than two adults in a room will incur an extra $30 charge per adult per night.

Check in time is no earlier than 2.00 pm & check out time is 10.00 am.

All bookings are subject to availability.

Pre and post accommodation is subject to availability at conference rate

A credit card authorisation will be required on check in. If a credit card is not available then a cash deposit of $150 will be required as security for any incidentals.

HOTEL USE ONLY:

Confirmed by:_____ ______________________Date: _________________________ Reference Number:___________________________

Scenic Hotel Te Pania 45 Marine Parade, PO Box 347, Napier 4140, New Zealand Ph: (06) 833 7733, Fax: (06) 833 7732 Email: tepania@scenichotels.co.nz