We work with a small number of education providers who share our commitment to excellence, evidence and the wellbeing of the veterinary profession. If that sounds like your organisation, we would like to hear from you.SECTION 1 | Provider detailsProvider name(Required)Provider type(Required)-- Select an option --In-practice run event for staff onlyCommercial/practice/companyGovernment/UniversityNot for profit organisation or associationSECTION 2 | Event organiser detailsPlease enter the details of the primary contact for this application.Name(Required) DrMissMrMrsMsProfRevSirColHonLadyOther Prefix First Last Practice Principal's AVA member IDAddress(Required) Street Address Address Line 2 City State Post Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email(Required) Website Phone(Required)SECTION 3 | Continuing Education activityWhat type of event is this activity?(Required) Single event (up to 4 hours) Events of one day (more than 4 hours) or more What is the delivery method for this activity?(Required) Seminar Conference Hands-on workshop or wetlab Assessed online activity Unassessed online activity Other Activity name(Required)Start date of activity(Required) DD slash MM slash YYYY End date of activity(Required) DD slash MM slash YYYY Additional date(s)If your activity/event runs for more than one day, or has multiple screenings, please note this here.Venue address(Required) Street Address Address Line 2 City State Post Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Please confirm: I will provide the AVA with a course schedule, including scheduled break time(s).(Required) I confirm this will be provided to the AVA. Company logo upload(Required)Please upload your company logo. Drop files here or Select files Accepted file types: jpg, png, Max. file size: 2 MB. Is there an existing link to register online? If so, please share it here: Duration of activity/event in hours (less any breaks):(Required)CPD points can be claimed from the minimum of 0.5 hours (i.e. 30 minutes) and above.Will there be any commercial promotion of products and/or services?(Required) Yes No If yes, enter the duration of the commercial promotion (in minutes):(Required)How many VetEd points are you applying for?(Required)Please state the number of VetEd points being claimed for this activity/event. - For more information on the amount of points to assign to your activity or event, please refer to the VetEd points allocation table. - Time spent on breaks or doing commercial promotion can not be counted towards Vet Ed points. - You can claim 0.5 points, but not less than this. Please share details of the course content:(Required)Description of the activity/event to appear on the AVA website:(Required)This description will appear as one (1) paragraph.Will this activity/event utilise animals as part of the program?(Required) Yes No If 'yes', will live animals or cadavers be used?(Required) Live animals Cadavers Are the live animals, equine or other?(Required) Equine Other Are they up to date with Hendra vaccination(s)?(Required) Yes No Are the cadavers ethically sourced?(Required)-- Select an option --YesNoWhere have the cadavers been sourced from?(Required)Ethics Approval Certificate upload(Required)Please upload Ethics Approval Certificate.Max. file size: 5 MB. SECTION 4 | Presenter detailsName DrMissMrMrsMsProfRevSirColHonLadyOther Prefix First Last Qualification(s)(Required)Please share the presenter's qualifications/credentials here.Speaker confirmation(Required) I confirm the following:(Required)1. The speaker has experience in the presentation and delivery of educational material and has recognised expertise (appropriate to the level of the course) in the field. 2. The speaker's resumé will be provided upon request by the AVA.SECTION 5 | Attendance record-keepingTERMS | Record-keeping of attendees(Required)1. Thorough records of delegate attendance will be kept. 2. AVA member IDs will be requested on registration. 3. A delegate list, including AVA member IDs will be forwarded to the AVA within two weeks of the even taking place. 4. A certificate of attendance will be given to all non-AVA member delegates. I agree to the above terms.SECTION 6 | VetEd approval application feesFor payment, I am:(Required) an AVA member, hosting an in-practice event for staff only. an other provider, please invoice my company / organisation / practice. Thank you, please note that nil payment is applicable.Accounts payable contactPlease provide a contact for the invoice to be sent to. First Last Account payable email CAPTCHA
