2011 School Registration Form for USA, NZ & Australia
Please print this page and post registration to the appropriate address. If there is no postal address, send the information via the e mail address given.
Raleigh, North Carolina, USA:Barbara Lepson, 1403 Clifton Pond Rd, Louisburg, NC 27549
Moravian Falls, North Carolina, USA: Mary Ann Ferguson e mail : maryann93063@yahoo.com
Brisbane, Australia: Anazao, P.O. Box 4102, Elanora, QLD 4221
Required Information
Circle the appropriate options below
North Carolina, USA/ Dunedin, NZ/ Brisbane, Australia
Week1/ Week 2/ Week 3/ Week 4
Single/ Couple
Full Name:............................................................................................................. Date:........................................
Postal Address........................................................................................................................................................................................................
Phone.(preferably mobile) ...................................................................... E mail....................................................................................................
Total Registration Fee............... [ NOTE: 50% deposit is required to secure registration. You can pay the total now. Balance on arrival. Refunds of deposit given in extenuating circumstances]
Balance Remaining...................
Circle payment method
Credit Card: CC Number..............................................................................Exp Date....../...... Name........................................................................
Personal Cheque ( made out to Anazao for Australian Schools and Peter Toth for NZ schools )
Bank Cheque/Money Order
Signed.............................................................................