CBNZ De-escalation Training Registration Form, 8 May 2017. Greenlane Christian Centre.

Please complete this form to register for this event.

Cost per person: $95. (CBNZ member $75) This includes morning/afternoon tea, and a light lunch (Subways).

CBNZ is very thankful to COGS Auckland and Manukau for supporting our work, which has enabled us to offer this training at a heavily reduced cost to everyone.

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* 1. Contact Details

First Name

Last Name

Street Address

Suburb

City

Postcode

Email Address

Contact Number

Emergency Contact Number

Name of Budget Service (if appropriate)

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* 2. Are you or your Budget Service a member of CBNZ?

Yes

Don't know

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* 3. Number of people attending

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* 4. Do any of the attendees have any special requirements? (Dietary, wheel chair access etc). If so, please give name and their requirements here. We will do our best to accommodate.

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* 5. Please list the names of ALL attendees

Name 1

Name 2

Name 3

Name 4

Name 5

Name 6

Name 7

Name 8

Name 9

Name 10

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* 6. Please note that refunds will only be given if cancellation is made 7 days before the event.

Please check box that you accept our cancellation policy.

THANK YOU for registering for the above event. An confirmation email invoice will be sent to you shortly with payment details (online banking is preferred please). Please advise if this does not happen.

Please email sarah@cbnz.org.nz if you have any queries or call her 03 342 7569 or 021 208 1121. We look forward to seeing you at this special event!

We look forward to seeing you!

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* 7. Sign me up to emails from CBNZ please?

Yes please

No thank you