QAPon-line Registration Form

	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 2021

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.



	2020 Schemes

Scheme Number/Discpline

Andrology

Embryology

Ultrasound

Please Note: The list displayed is only for scheme that require a paid subscription. Other schemes that are free are not displayed.

Sperm Motility.	Sperm Morphology-WHO 5th Edition 2010
Sperm Concentration-haemocytometer	Sperm Concentration-Makler
ASAB by Immunobeads Assay	Halosperm EQA
Sperm Chromatin Structure.	Sperm Vitality EQA
Teratozoospermia Index TZI	SQB - SQA EQA Concentration
SQB - SQA EQA Concentration	SQB - SQA EQA Concentration
SQB - SQA EQA Concentration	Pronuclear Embryo Assessment
Embryo Fragmentation.	Human Cleavage Embryology
Late Human embryology	Oocyte/Cleavage/Blastocyst Ranking
Embryo Cleavage by Time Lapse Evaluation	Time-Lapse Ranking
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
IVFCPD group subscription	400	750	400

*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:

---

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::