ENROLMENT & PAYMENT AUTHORISATION for Workshop: THREE DAY INTRODUCTION TO INDIVIDUAL SCHEMA THERAPY: BENDIGO, VICTORIA Date: Thursday 25th of MAY 2017 to Saturday 27th of MAY Click on the Attendee Name field and press TAB to move through the form Attendee Name Attendee Email Address Attendee Contact Number (preferably mobile) Payment Note: Credit Card (Visa or Mastercard only): Cardholder Name Amount to be paid $699 Early Bird (incl. GST) $740 AFTER MARCH 31st Credit Card Number Credit Card Expiry CCV (3 digits on the back) Please email this form to: ABN 45 728 229 604 www.schematherapyaustralia.com.au Email:
ENROLMENT & PAYMENT AUTHORISATION for Workshop: THREE DAY INTRODUCTION TO INDIVIDUAL SCHEMA THERAPY: BENDIGO, VICTORIA Date: Thursday 25th of MAY 2017 to Saturday 27th of MAY Click on the Attendee Name field and press TAB to move through the form Attendee Name Attendee Email Address Attendee Contact Number (preferably mobile) Payment Note: Credit Card (Visa or Mastercard only): Cardholder Name Amount to be paid $699 Early Bird (incl. GST) $740 AFTER MARCH 31st Credit Card Number Credit Card Expiry CCV (3 digits on the back) Please email this form to: ABN 45 728 229 604 www.schematherapyaustralia.com.au Email: