Ili Ili Stones Register

NAME*:
OCCUPATION*:
ADDRESS*:
CITY*:
STATE/TERRITORY*:
POSTCODE*:
DATE OF BIRTH*:
EMAILADDRESS*:
PHONE NO.*:
MOBILE:
I HAVE SPECIAL DIETARY REQUIREMENTS - PLEASE SPECIFY

I AM ABLE TO BRING MY OWN MASSAGE TABLE
I WISH TO ATTEND THE FOLLOWING COURSE
WEEKEND RETREAT COURSE $660 (incl. GST)
EARLY BIRD (PAID IN FULL 1 MONTH EARLY) $550 (incl. GST)
OR
DAY COURSE $550 (incl. GST)
EARLY BIRD (PAID IN FULL 1 MONTH EARLY) $450 (incl. GST)
OR
CALL ME TO ORGANIZE $100 DEPOSIT TO SECURE PLACE.
AND
PLEASE ACCEPT MY PAYMENT FOR THE COURSE I UNDERSTAND THAT IF I CANCEL A DEPOSIT AMOUNT OF $100 IS NOT REFUNDABLE BOOKING WILL BE CONFIRMED UPON RECEIPT OF PAYMENT
Please copy the letters shown here into the box below. (case sensitive) *:

NEXT COURSE
Albert Park September
27/28