REGISTRATION

Corpus Medicorum encourages doctors and medical students not to forgo their substantial talents during the long years of medical training. It also provides a highly satisfying creative outlet for practicing medics to balance their demanding professional lives.

Our Mission is to blend Medicine, Community, Philanthropy, and Music. Please join us on our Grand European Tour!

For all travel enquires please email anj@worldwidetravel.com.au. I am in Canada visiting family so with the time difference email is the best method of contact until September.

Fields marked with an * are required

Name *
Name
Postal Address *
Postal Address
PERSONAL INFORMATION
Name *
Name
(As shown on passport)
(if you are a supporter please leave blank)
PASSPORT DETAILS
Passport Issue Date
Passport Issue Date
Passport Expiry Date
Passport Expiry Date
airline details
Please Select
** If yes, please fill in separate form for each traveller **
PACKAGE
If YES, skip to (d)
(b) Which package(s) are you most interested in booking?
Please select
(c) Are you interested in staying on in Europe and/or a stopover in Singapore?
Please select
PAYMENT OPTIONS
Registration is $650pp for musicians and $150pp for accompanying travellers.
This is waived for children under 12 and medical students on scholarships.
Fill in the fields below if paying by Credit Card.
If selecting Direct Deposit submit your registration and follow the Direct Deposit instructions.
I hereby authorize you to debit my credit card as follows:
$
To Agree to this Charge Please Type your Name
To Agree to this Charge Please Type your Name

Direct Deposit Details

Bank:                    ANZ
BSB:                      013 445
Account:             382144068
Name:                  World Wide Travel
Ref:                        Your Surname-CM2018

 

info@corpusmedicorum.org.au