Please complete the following registration form and send it with your payment in Australian dollars to: Worldwork P.O. Box 791 Australia Post Brookvale Business Centre 15/9 Powells Rd. Brookvale Sydney, NSW. 2100 Australia

NAME:

ADDRESS:

 

 

EMAIL:

TELEPHONE (including country and area code):

MOBILE PHONE:

FAX:

 

ROOM REGISTRATION

Rates include lodging for 8 nights, all meals, teas and use of facilities, and are per person. Please check one of the following accommodation packages:

Please check one of the following options:

____ Double room ($Aus.586)

____ Cabin bunkroom ($Aus.450)

____ Single (off site) ($Aus.1120)

____ Child-Rate (please contact us for the appropriate rate and fill in)

SPECIAL NEEDS

____ I will be needing easily accessible lodging  

____ I will be needing special assistance (please elaborate):

ROOMMATES

My roommate(s) is/are:

1.

2.

3.

4.

Please assign me:

1 __ 2 __ 3 __ 4 __ roommates

I prefer to room with:

women __ men __  no preference __

smokers __  non-smokers __ no preference __

MEALS

Please indicate your food preferences so we can best accommodate your needs.

I eat only vegetarian food __

I eat vegetarian food and fish __

I eat vegetarian food, fish and meat __

I would like soy milk at breakfast __

I would like light/non-fat milk __

CHILDCARE

I would like childcare __

Please indicate the number of children, their names and ages:

 

 

DEPOSITS & PAYMENTS

All payment must be made in Australian dollars. We accept international bank drafts, Australian cheques, and Australian money orders. Please make out all payments to Global Process Institute. We also accept credit card payments. Please add $25.00 Australian to cover credit card fees, per credit card payment. We accept Visa and Mastercard. Please include any additional bank fees in your payment. Thank you for helping us .

Enclosed are the following deposits and payments in Australian dollars:

_____ $ deposit for tuition ($300)

_____ $ deposit for accommodation package ($300 )

_____ $ deposit for day registration ($200)

_____ $ fee for credit card payment ($25)

_____ $ Total Payment (Check to: Global Process Institute)

_____ $ Separate donation to the scholarship fund. (Write check to: SCHOLARSHIP FUND and send to U.S. address given above.)

Credit card payment ____ Visa ____ Mastercard

Full name as shown on card _________________________________________

Credit card number_______________________________________________

Expiration date _____________________

Signature ____________________________________ Date ____________

WAIVER

Please sign and date below. I understand that this is essentially a personal growth and training seminar. I agree to assume full responsibility for participation in this seminar and all that I experience.

 Signature:

 Date: