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Event Management Application
Please complete the form below to give us some information regarding your event requirements.
DIVISION CONTACT INFORMATION
Division/Study Group
*
-- Please select from the following --
ACT South Tablelands
Central Coast
Eastern Suburbs Dental Group
Far North
Hills Dental Study Group
Inner West Dental Group
Manly Warringah Dental Study Group
Multidisciplinary Grand Rounds study Group
Nepean and District Dental Group
Newcastle
North and North West
North Eastern
Northern Suburbs Dental Group
South Coast
Southern
St George Dental Association
Tasmania
Western
Women's Study Group
--NONE--
Contact Name
*
Contact Number
*
Contact Email
*
EVENT TYPE
Event Type
*
Seminar
Networking Event
Sporting Event
Advertisement Only
Structure of Event
Lecture
Hands-on Workshop
Panel Discussion
Other (please specify)
Length of the Event
Half day
Full day
Evening
Other (please specify)
EVENT DETAILS
Event Date
*
Please specify the event times including start and end times
*
Speaker
*
I have chosen a speaker (please provide name below)
Please find me a speaker
Speaker not required for this event
Event Venue
*
I have chosen a venue (please provide details below)
Please find me a venue
EVENT ATTENDEES AND FEES
Who can attend the event (select all relevant)
*
ADA Member
Non Members
Dental Team
Others (please specify)
Do you have registration fee(s) set for this event
*
NO (please calculate it for me)
YES (please provide it below)
EVENT ADMINISTRATION
Are there CPD hours applicable to this event?
*
NO
YES (please specify)
Event materials required
Nametags
Certificates
Hand outs
Clinical Instruments
Others (please specify)
Audio/Visual Requirements
Projector/Screen
Microphones (Hand held)
Microphones (Lapel)
Others (please specify)
Sponsorship/Support Requirements
Sponsor has been confirmed
Help me find a sponsor
No Sponsor required
OTHER EVENT INFORMATION
Name of the Event
*
Sub-Title
Event Summary
*
Event Topics
Event Objectives
Event Other Information
Event Image
Upload file
Please ensure all mandatory fields have been completed before submitting the form.