REGISTRATION FORM
MUSCLE BALANCE ANALYSIS SEMINAR
Fairway Lodge Function and Conference Centre
7 Argus Place, Takapuna, Auckland
www.fairwaylodgeauckland.co.nz
5th & 6th MARCH,
2011
Saturday & Sunday, 8:30 a.m. - 5:30 p.m.
(NOTE: Sign in from 8:00 – 8:30 a.m. Saturday)
Name:_______________________________________________________________________________________
Phone:_________________________________________Mobile:________________________________________
E-mail:________________________________________________Profession:______________________________
NZ$510 Standard registration, received through 25 Feb 2011
NZ$615 Late registration, received after 25 Feb 2011
NZ$ 55 Goniometer (each) (Optional, but highly recommended; please click here for details)
______ TOTAL
Please do not enclose cash.
Please Fax your completed form to (09) 476 4948,
OR post this form with enclosed cheque to:
MBA Pain Relief Seminars
M110, Private Bag 300 987
Albany, Auckland
Signature___________________________________________________
For more information, please contact: