Registration for: REBELS WITH A CAUSE
(Printable form - please write legibly)

NAME:

ADDRESS:

PHONE NUMBER(S):

E-MAIL ADDRESS:

____ I will attend Friday only. (Cost $150)

____ I will attend Saturday only. (Cost $150)

____ I will attend both Friday and Saturday. (Cost $250)

____ I would like a copy of the book, Rebels with a Cause,
       at the discounted rate of $40  (Cover price: $49.95)

My total fee is: $____________

Either:

_____ I enclose a deposit of $50 and will pay the balance of $_______ upon registration.

Or:

_____ I enclose payment in full with 10% discount from tuition (and book cost):
           Note: This is due 7 days prior to the workshop.

_____ One day registration at $135

_____ One day registration plus book at $171

_____ Two day registration at $225

_____ Two day registration plus book at $261

Please make cheques payable to:
Queensland Training Institute of Psychodrama (QTIP) and mail, with registration form to:

PO Box 1755
Coorparoo Mail Centre
Brisbane 4151

For further information contact Peter Howie on 04 1187 3851 (please leave a message if unavailable) or Ken Connel on 04 1123 3755

________________________________________________________

Rebels with a Cause
Background Information
Training / Workshops Offered
Clinical and Psychodrama Supervision
Publications and References
Byron Bay Registration Form
Contact Me

 

ByronEvents.net