Registration Form for Dunedin, NZ "Conflict Resolution and Marriage" Seminar - Sept 19-23, 2011

Please print this form and post the registration to: Fiona Todd, 30 Lawson St, Belleknowes, Dunedin, NZ You can phone Fiona on (03) 477 4798. 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. Fiona's e mail is fionatodd@callsouth.net.nz

Fees

Conflict Resolution only: (19,20,21 Sept ) $165 pp or $250 per couple.

Marriage only: (22,23 Sept ) $110 pp or $180 per couple

The Full Week (Conflict Resolution and Marriage) (19-23 Sept) $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..............................................