Registration Form for Christchurch, NZ "Conflict Resolution and Marriage" Seminar - August 10-14, 2009

NOTE: Sometimes older printers will not print all of this registration form. Click here to print a PDF version.

Please print this form and post the registration to:Janne Sergison, 37 Somerfield St, Christchurch 8024. You can phone Janne on (03) 9422362. Alternatively, you can send the registrations forms to Anazao, P.O. Box 4102, Elanora, QLD 4221

Another option is to send the same information in an e mail. Supplying credit card details by email is normally safe but you do so at your own risk. The e mail address is phtoth@anazao.com.au. Janne's e mail is chloes.mum@paradise.net.nz

Fees

Conflict Resolution only: (10,11,12 Aug ) $165 pp or $250 per couple.

Marriage only: (13,14 Aug ) $110 pp or $180 per couple

The Full Week (Conflict Resolution and Marriage) (10-14 Aug) $250 pp or $400 per couple

Required Information

Circle the appropriate choice:

Single

Couple

Full Week

Conflict Resolution only

Marriage Only

Please complete the following:

Full Name:...............................................................................................................

Postal Address........................................................................................................................................................................................................

Phone.(preferably mobile) ...................................................................... E mail....................................................................................................

Total Registration Fee............... [ NOTE: Total amount required on registration]

Circle payment method

Credit Card: CC Number.........................................................................Exp Date......./.......Name..........................................................................

Personal Cheque ( made out to Peter Toth)

Bank Cheque/Money Order

Signed.............................................................................Date..............................................