REGISTRATION FORM

REGISTRATION FORM

MUSCLE BALANCE ANALYSIS SEMINARS


AUCKLAND	PALMERSTON NORTH
Fairway Lodge Function & Conference Centre 7 Argus Place, Takapuna, Auckland www.fairwaylodgeauckland.co.nz	Kingsgate Hotel Palmerston North 110 Fitzherbert Ave., Palmerston North http://www.millenniumhotels.co.nz/kingsgatepalmerstonnorth/index.html
26^th & 27^th SEPTEMBER, 2009	31^st OCTOBER & 1^st NOVEMBER, 2009

Saturday & Sunday, 8:30 a.m. - 5:00 p.m.

(NOTE: Sign in from 8:00 – 8:30 a.m. Saturday)

Name:_______________________________________________________________________________________

Phone:_________________________________________Mobile:________________________________________

Address:_____________________________________________________________________________________

E-mail:________________________________________________Profession:______________________________

REGISTRATION
Note: Registration fee includes morning and afternoon tea.

I am registering for the seminar in (Please tick one): _____Auckland (26-27Sep09) _____Palmerston North (31Oct-1Nov09)

I enclose (Please circle those that apply):

$445 Early registration, received through 11 September, 2009 (Auckland) or 24 October, 2009 (Palmerston North)
$545 Late registration, received after 11 September, 2009 (Auckland) or 24 October, 2009 (Palmerston North)
$ 49 Goniometer (each) (Optional, but highly recommended; please click here for details)

______ TOTAL

REFUND POLICY:
Requests for cancellation of registration received by post, email, or fax on or before the Early Registration Date (Auckland = 11 September, 2009; Palmerston North = 24 October, 2009) will receive a refund of all tuition paid, less an administrative fee of $90.00. Due to the need to confirm seminar arrangements well in advance, refunds cannot be given for refund requests received after the Early Registration Date for that seminar. MBA Pain Relief Seminars reserves the right to cancel any seminar, in which case all tuition paid will be refunded in full. If a seminar is cancelled, MBA Pain Relief Seminars is not responsible for the costs of any guaranteed airline, hotel, or other travel reservations. If a seminar is cancelled and you wish to transfer your registration from that MBA seminar to another, no transfer fee will be charged.

My method of payment is: Cheque / Internet banking (circle one) [Please do not enclose cash]

Please make cheques payable to : Muscle Balance Analysis Seminars

Internet Banking: 06-0998-0022368-00
VERY IMPORTANT: Please reference your Internet payment with your SURNAME in the “Reference” option.

Please post this form - with cheque payment (if applicable) enclosed - to:

MBA Pain Relief Seminars

M110, Private Bag 300 987

Albany, Auckland 0752

Signature___________________________________________________

For more information, please contact:
Kate Carlisle, C.N.M.T., R.N. • PH: (09) 476 4949 • Mobile: 0274 206 147 • Email: painrelief@paradise.net.nz