Surname (Mr/Mrs/Ms/Miss/Dr/Prof):
First name:
Date and country of birth:
Position (if applicable):
Name of organisation (if applicable) and address (including post code and country):
Residential address:
Tel (BH):	Tel (AH):
Mobile tel:	Fax:
Email address:
PAYMENT OPTIONS (please tick preferences) [ ] $NZ890 (full cost, including $NZ140 deposit, for bookings after May 1, 2009) [ ] $NZ700 ("early bird" fee, including deposit, for bookings before May 1, 2009) [ ] $NZ100 discount per person for three or more bookings from the same organisation [ ] Enclosed is my deposit of $NZ140-00 (non-optional) Payment method: [ ] cheque* [ ] money order* [ ] electronic funds transfer (details available on request - please post form when transmitting funds) *payable to Peter Spinks
I have read and agree to the conditions of registration as outlined below.
Participant's signature:	Date:

Conditions of registration: * Any booking cancelled before May 1, 2009 will be refunded less a $NZ40 administration fee; a 20 per cent cancellation fee will apply after this date. * No refund for any cancellation received after May 20, 2009. * Cancellations must be in writing. * A substitute is welcome if an enrolled participant cannot attend. * A deposit is forfeited if the balance is not paid by the start of the workshop. * Peter Spinks is not liable for circumstances that may force this workshop to be cancelled or postponed. If this happened, participants would be given the option of attending at another time or of a full refund. * All information provided on this form is strictly confidential.

Please print out this form, complete it clearly in block capitals and post with your remittance to: Peter Spinks, PO Box 409, Romsey, Victoria 3434, Australia.