A copy of your registration will be sent to your email address where it can be printed and saved.
Date of the training event I am registering for :
Name :
Qualifications/course :
Professional affiliations :
Do you have any special learning needs?
Address :
P/C :
Phone (H) : (W) :
Email :
Emergency contact name :
Emergency contact phone number :
Select your method of payment : Credit CardDirect Debit
I am making a deposit (minimum deposit is AU$50.00) or payment in full (AU$975.00 (students and first-year graduates $955.00) to Wise Woman Business. Direct debit details are: Wise Woman Business NAB, BSB 083 166, Account number 52920 8370. / / / / Expiry date / /
International registrants pay in AUD$. For EFT the Swift code is nataau3303m and address is 566 Burke Rd, Camberwell, VICTORIA, Australia 3124
Please complete and return this document by email to Dr. Hampton before your appointment.
Name(s) :
Phone :
Select your preferred method of payment : Credit CardDirect Debit
