CBNZ Behaviour Change & De-escalation Training Registration Form, 30 March, 2019, Porirua Gospel Chapel

Please complete this form to register for this event.

Cost per person: $95. This includes morning tea, and a light lunch (Subways).

(CBNZ members $75. Agape Budgeting Service have a limited number of sponsorships for its staff/volunteers to attend.)

Question Title

* 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)

Question Title

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

Yes

Agape Budgeting Service Staff/Volunteer

Don't know

Question Title

* 3. Number of people attending

Question Title

* 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.

Question Title

* 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

Question Title

* 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!

Question Title

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

Yes please

No thank you