On-line Registration Form

for the Intensive Workshops in July 2011 and February/July 2012

Cost: $570.00 (includes all workshop materials, lunches and refreshments)

Your Details
     
Full Name
   Title
Home Address
  
Home Phone
  
Home Email
  
Degree
  
   
     
Your Work or School (Agency)
     
Agency Name
  
Address
  
Phone
  
Email
  
     
Occupation/Job Title  
     
     
Which Workshop are you registering for (Basic & Advanced are run on the same dates)
     
The Type of Workshop  


     
* Please give details of the Basic Practicum below (required for Advanced Workshop Application Only )
     
Practicum Supervisor's Name  
Location  
 
 
Payment Methods
     
You can either make a deposit payment (min $100.00) or a Full Payment of $570.00 - please choose below:
     
Deposit Payment
   of Full Payment of $570.00
     
     
I would like to make my on-line payment with PayPal/Cedit/Debit Card
 
Other Information:
 
Please Read:
 

When you click send your registration application will be email to us and you will automatically be re-directed to an on-line payments page. Your workshop placement will be confirmed by email once payment has been received.

Should you wish to cancel your place on the workshop, you must do so no later than 2 weeks before the workshop start date otherwise a $25.00 administration cost is applicable.

 
You must tick this box to to continue .
 
 

To help prevent spam:
 
security code
Re-type numbers from above: