HIC 2019 Volunteer application

Welcome to the HIC volunteer application form

The HIC student program is proudly sponsored by:

Thank you for your interest in volunteering at HIC 2019. Please use the following form to outline your areas of interest and availability. This process will also pre-register your attendance but is not a guarantee of your volunteer position.

Applications close on Friday 5 July and we will contact you by Friday 14 July 2019 to advise of the volunteer position outcomes.

Please note: Whether you reside in Melbourne or are joining us from interstate, you must arrange and pay for your own travel and accommodation for the duration of the conference.

Be advised of the following general conference times when organising your participation. Further details will be provided closer to the conference date.

Monday 12 August - 7:00 am - 5:00 - pm (Networking Reception 5:00 pm - 7:00 pm)
Tuesday 13 August - 7:00 am - 6:00 - pm (Gala Dinner 7:00 pm - 11:00 pm )
Wednesday 14 August - 7:00 am - 4:00 pm

Note: Preference will be given to candidates who are able to join us for the 3 days. Volunteers are invited to attend the networking reception free of charge, however, the Gala Dinner will incur a charge of $175. Pre-conference events may also be purchased at advertised prices

Please contact HISA either by email: hic@hisa.org.au or telephone +61 3 9326 3311 should you have any questions regarding this.

Not sure of your member number? Follow these steps to retrieve it:
1. Log into your member account by clicking here.
2. Your member ID is listed on the first page under Account Information.

Still having trouble? We’ll be happy to help. Please email membership@hisa.org.au or phone HISA HQ on +613 9326 3311 and one of our staff can assist.

Volunteer_HISA Member FULL

Volunteer_Non Member FULL

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

Title

First Name

Last Name

University (as you would like it listed on your name badge)

Degree being studied

Email Address

Verify Email Address

Mobile

Address

Address City

Address State

Address Postcode

Emergency contact

Emergency contact name

Emergency contact number

Do you have any dietary requirements (Please note these are dietary requirements not taste preferences)

Do you have any special requirements (e.g. mobility, access)?

How did you hear about HIC 2019?

Attended previous HICconference

Colleague or friend

Employer

Facebook

From an organisation I am a member of

Google

HIC email

HISA News

HISA state branch event

HISA website

LinkedIn

Magazine or journal

Other

Twitter

University

Volunteer availability (Please only select the days you are able to commit to 100%)

Monday 12 August 2019

Tuesday 13 August 2019

Wednesday 14 August 2019

Volunteer T-Shirt size

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected you heard about HIC through Facebook was this from an ad or the HISA page?

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected that your heard about HIC from LinkedIn is this from an ad or the HISA page?

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected other for how you heard about HIC. Please provide details below

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected that you heard about HIC from a state event. Can you please advise which state branch?

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected that you heard about HIC through a University. Please provide the name of the University

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected that you heard about HIC through an organisation you are a member of. Please provide the name of the organisation

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected that you heard about HIC from a magazine or journal. Please provide the name of the publication

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

You selected that you heard about HIC from a colleague or friend. Please provide their full name

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

Social Functions

Volunteers are invited to attend the networking reception free of charge, however, the Gala Dinner will incur a charge of $175. Please indicate at this stage if you wish to attend. Your attendance will be confirmed when you have been accepted as a volunteer.

Networking Reception: Additional tickets may be purchased at a cost of $77.00 per person.
HIC 2019 Gala Awards Dinner: Additional tickets may be purchased at a cost of $175.00 per person.

Please indicate the number of additional tickets required below.

Networking Reception

Date: Mon, Aug 12, 2019 Time: 5:30 PM - 7:30 PM

Delegate ticket FULL

I will not be attending the networking reception FULL

Purchase additional ticket

Additional ticket FULL

77.00

HISA Awards Gala Dinner

Date: Tue, Aug 13, 2019 Time: 6:30 PM - 11:00 PM

Delegate ticket FULL

175.00

I will not be attending the Gala awards dinner FULL

Purchase additional ticket

Additional ticket FULL

175.00

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

Why do you want to be part of this program and what do you hope to achieve from being a volunteer?

What do you believe you can bring to this role?

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

Thank You

Health Informatics Society of Australia (HISA Ltd) Level 1, Suite 1.02A, 85 Buckhurst Street, South Melbourne, Victoria 3205
t: +61 3 9326 3311 e: hic@hisa.org.au w: hisa.org.au/hic

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