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PO Box 244    THE JUNCTION

NSW 2291 AUSTRALIA
FertAid Pty Ltd            [ABN 62-093-199-529] Quality Matters  
   
TAX INVOICE - PLEASE PRINT AND POST or FAX 61-(0)2-49-63-1228 TO SUBSCRIBE WITH PAYMENT. www:fertaid.com - office@fertaid.com

Clinic (group) Subscription to QAPon-line at FertAid.com for 2011

Registration Process

 1. Read the page 'About QAP-online.com'  including the Declaration.

 2. Read 'About Subscribing to QAP-online.com

 2. Read 'Review QAP Scheme available Read Fees

 3. PRINT to PDF and email to office@Fertaid.com OR post to FertAid  with payment.
 
 
 
Scheme Number/Discpline
Andrology
Embryology
Endocrinology
Ultrasound
Please Note: The list displayed is only for scheme that require a paid subscription. Other schemes that are free are not displayed.
Sperm Morphology - WHO 4th Edition. Sperm Motility.
Sperm Morphology-WHO 5th Edition 2010 Sperm Concentration-haemocytometer
Sperm Concentration-Makler ASAB by Immunobeads Assay
Halosperm EQA Sperm Chromatin Structure.
Concentration/Motility EQA-CASA SCA - MicrOptics Sperm Morphology EQA- CASA SCA system - Microptic
Pronuclear Embryo Assessment Embryo Fragmentation.
Human Cleavage Embryology Late Human embryology
Human Ova anti-Müllerian hormone [AMH]
Endocrinology-Follicular Phase Serum Oestradiol Endocrinology-Follicular Phase Serum FSH
Endocrinology-Follicular Phase Serum LH Endocrinology-Follicular Phase Progesterone
IVF Endometrial Estimation IVF ultrasound
Type of Subscription
 

 

 
Individual One Staff/One scheme Discipline * All staff/One Discipline
Scheme* All staff/one scheme Global * Al Staff/All schemes
*,QAP-online will create a record of your subscription as the QAP supervisor and your Clinic as a QAP group. Your staff will be able to register online, link their registration to your QAP group and then enroll online without further payment.
 
Payment

Please complete payment details for all staff in the one clinic. Please write clearly

Fee*
$USD
$AUD
Euro
Education 2011/Laboratory
0
0
0
Scheme-2012
500
550
300
Halosperm Sperm EQA
400
400
300
Single-2012
50
55
40
Discipline-2011
1000
1100
500
Individual Education Subscription 2011
0
0
0
Sperm DNA EQA
500
550
300
Global-2011
1000
2200
500
BM2011
200
250
150
Endocrine
500
550
300
CPD2011
0
0
0
MicrOptics SRC EQA 2011
0
0
0

*inc GST

Individual One Staff- one scheme
Scheme All staff- one scheme
Discipline All staff - one discipline
Global All staff- all schemes

 
AMOUNT DUE: $USD $AUD Euro
Cheque Credit Card Bank Transfer Order Number
Credit Card. Details: Card Holders Name [Please Print Clearly]:
VISA  MasterCard Bankcard  CVV 3 Digit Authority Code
Name on Card:    Signature:      Expiry Date:
       
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Direct Bank Transfer Payable to Commonwealth Bank of Australia   Acc Name: FertAid - Bank Code: CTBAAU2S  Acc No: 062-821-1009-4608
Transferring Bank
      Date Transfer Requested:
 Order Number:   Name of Authorising Authority:   Signature:

Contact Details

Details of Clinic and Contact Details of Authorised Staff Member

[your logon code and  password will be sent to this e-mail if completed- please print clearly]

Office Use Only:Clinic:_________

Logon:_________Password:___________
Your Full Name:
  - Signature Date :
Institution/Clinic
 
Address:
 
:Telephone:
  Fax:
  e-mail address::