Enabling Change Series Workshops: Registration

To register your places in our Enabling Change series of workshops please complete the form below.

Payment method

Upon conforming your registration we'll issue your organisation with an invoice. Payment of this invoice can either be made via EFT or cheque.

Cancellation fee

Please note...

Enabling Change Workshop Series: Registration Form
Places
Number of places you wish to register :	Select 1 2 3 4 5 6
Organisation Details
Organisation Name:
Postal Address:
Town/Suburb:
State:	Select NSW VIC ACT QLD TAS SA WA NT
Postcode:
Telephone:
How did you find out about this workshop?	Select Google ad Google search Social Change Media website Brochure received via fax Brochure received via email Social Change Friends e-Newsletter From a colleague From Les Robinson Other
Participant Details
Workshop:	Select Promoting Healthy Behaviours ($990 inc. GST)
City:	Select Brisbane Melbourne Perth Sydney
Participant 1 Name:
Participant 1 Job title:
Participant 1 Email:
Participant 2 Name:
Participant 2 Job title:
Participant 2 Email:
Participant 3 Name:
Participant 3 Job title:
Participant 3 Email:
Participant 4 Name:
Participant 4 Job title:
Participant 4 Email:
Participant 5 Name:
Participant 5 Job title:
Participant 5 Email:
Participant 6 Name:
Participant 6 Job title:
Participant 6 Email:
Do you have any special dietary requirements?
Type the characters exactly (including correct case) as displayed in this picture. (this prevents spam robots abusing this form)

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Last Modified: Wednesday, 29-Aug-2007 11:25:26 EST