Rural Health Club
ARMS
AURHA
AWAIRH
BREAATHHE
BUSHFIRE
CARAH
CRANC
FURHS
HOPE4HEALTH
KRASH
LARHC
MARHS
MIRAGE
NERCHA
NOMAD
Outlook
RAHMS
RHINO
RHUUWS
ROUNDS
ROUSTAH
Rustica
SHARP
SPINRPHEX
StARRH
TROHPIQ
WAALHIIBE
WARRIAHS
WILDFIRE
Student Title
Mr
Miss
Mrs
Ms
Student Name
Are you of Aboriginal or Torres Strait Islander descent
Yes
No
University
Course
Year of Study
Postal Address
Please include address, suburb, state and postcode:
Email Address
Mobile Number
Phone Number
Description of applicant contribution to Rural Health Club
Please provide a detailed description of your past and current involvement with your Rural Health Club:
Conference Name
Dates of Conference
Location of Conference
Description of Conference
Please provide a description of the conference including theme, target audience and any focus on rural and remote health:
Registration Costs for Conference
Please include registration costs as well as early bird costs and closing dates for registration:
Relevance to principles of the National Rural Health Students' Network and Rural Health Club Movement
Student presenting at Conference
This is encouraged and looked upon positively by the CoNS Committee.
Yes
No
If Yes , what are you presenting on; If No , why:
Alternate funding sought
This is encouraged and looked upon positively by the CoNS Committee as it assists in spreading the CoNS funding across more Rural Health Club members.
Yes
No
If Yes, where from, how much and have you received this funding; If No, why:
Flight to Conference
Yes
No
Date
Flight Number
Departure Location
Departure Time
Arrival Destination
Arrival Time
Cost (inc GST)
Flight from Conference
Yes
No
Date
Flight Number
Departure Location
Departure Time
Arrival Destination
Arrival Time
Cost (inc GST)
Other Travel to and from Conference
Yes
No
What (taxi, airport bus etc.) and costs involved:
Accommodation during the Conference
Yes
No
Name and cost of accommodation sought:
Check-in and check-out dates:
Responsibilities upon return from the Conference
Please detail how you plan on representing your experiences and knowledge gained at the conference to your Club and fellow students:
Conference Registration Form, Program and Presentation Abstract (if applicable)
Email as attachments to Jane
Application Checklist
Read the CoNS Guidelines to make sure that you have included everything that is required
Complete this form including registration, accommodation and travel details/costs
Emailed through your letter of support from your RHC executive
Application Process
Your application will be forwarded on to your Clubs NRHSN Senior Representative for confirmation of approval
Once your application has been received it will be emailed to the CoNS Committee for assessment
You will be advised whether your application has been successful within 1 month of receipt of your application
If your application is successful the NRHSN will then organise, book and make payment or reimburse you if you prefer to book yourself
Have you read and accepted the Cancellation policy terms and conditions
Yes
No