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Thank you for submitting your application for enrolment!

Our team aims to process your enrolment and send you confirmation within one week.

If your enrolment confirmation is urgent, or you are applying for a course commencing in less than 2 weeks, please email us at admin@whta.com.au to alert us of this.

Name (FIRST and LAST NAME)*

Have you enrolled in PELVICON 2023 in Atlanta?*

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Have you enrolled and been confirmed as having a place in the Pelvicon Pre-Conference Pessary Workshop?*

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SELECT COURSE FOR ENROLMENT*

Have you completed this specific course before? (ie are you repeating this course as a refresher)*

Select an option

Email Address for Enrolment*

Physiotherapists email for Online Portal Link*

Postal Address: Number and Street (for delivery of Manual)*

Suburb, State & COUNTRY*

Postcode / ZIP code*

Phone Number (mobile)*

Are you a WHTA Member?

Select an option

FOR NON-MEMBERS: Would you like to apply for WHTA lifetime membership (AUD$90 ex GST) to receive the membership rate on your enrolment (AUD$620)?

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Intellectual Property / Copyright*

Payment Terms*

Payment Type

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