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PO Box 244    THE JUNCTION

NSW 2291 AUSTRALIA
FertAid Pty Ltd            [ABN 62-093-199-529] Quality Matters Phone: 61-(0)2-4963-1226
  Fax     :61-(0)2-4963-1228
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 2012

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 and complete this form then post to FertAid  with payment.
Scheme Number/Discpline
Andrology-QA
Andrology-Testing
Embryology
Endocrinology+AMH
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
Concentration/Motility EQA-CASA SCA - MicrOptics Sperm Morphology EQA- CASA SCA system - Microptic
Halosperm EQA Sperm Chromatin Structure.
Embryo Fragmentation. Pronuclear Embryo Assessment
Human Cleavage Embryology Late Human embryology
Claevage/Blastocyst Ranking and Selection 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
2012 Lab Fee
200
220
100
Single-2012
50
55
40
Scheme-2012
500
550
300
Sperm DNA EQA 2012
750
750
500
Halosperm Sperm EQA
400
440
300
Discipline-2012
1000
1100
500
Global-2012
2000
2200
1000
Endocrinology 2012
550
550
400
CASA EQA 2012 for MicrOptics SCA
300
330
200

*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 
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::