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eHealth Network

Victorian eHealth Network

The Victorian eHealth forum presents an opportunity to hear four speakers, and to network over morning tea refreshments with a select group of eHealth company owners, researchers, university professionals and multinational organisations.

The forum is sponsored by Multimedia Victoria in association with the Australian Industry Group.

The forum will be held on:
Thursday 15 May 2008
10:30am to 12 midday
Level 46, 55 Collins Street, Melbourne.

Please register your ability to attend the forum by completing the form below. We are asking you to respond to some questions along with your registration so we can have some notion of each participant's eHealth capabilities that will inform how we conduct the event in the most efficient manner, and add your eHealth capabilities to our knowledge-bank.

Your privacy will be respected. No company names or data will be published without your consent. The information collected will only be used for the purpose for which you have provided it, unless consent is otherwise provided.


* denotes a mandatory field

Contact Details

Company Name*

Name*

Address*

Telephone*

Mobile

Email*

Website*



What does your organisation do? *


What are your organisation's main eHealth capabilities/solutions? *

assessment technologies

clinical assessment

core planning / management systems

health records

informatics

medical simulation

standards

support systems

telemedicine

other


Where do you currently offer your eHealth solutions? *

Victoria

other parts of Australia

Overseas


What type of organisation are you? *

Government
Health Service Provider
Industry Association
Multinational
Research Institute
Small to medium sized business
University
Other (please specify below)

What is the approximate size of your organisation? *

small (0-19 full-time employees)
medium (20-199 full-time employees)
large (200+ full-time employees)

What is the annual revenue of your organisation?


Event Registration *

I am able to attend the forum on 15 May 2008
I am unable to attend the forum on 15 May 2008

I authorise my name and organisation name to be distributed to forum attendees on the day of the forum.

I am aware that Multimedia Victoria may pass on the information provided by you to third party bodies strictly for the purpose of the preparation and forming of a future Victorian eHealth Network