Registration for "Making A Clean Breast Of It"

Your details

Name*:

Daytime Phone:

Mobile:

Street address 1*:

Street address 2:

Town or Suburb*:

State*:

Postcode*:

Country*

Accomodation

Please advise me on local accommodation options.

Payment

The full cost of this workshop is $130. Please pay a $35 deposit to reserve your place. To pay your deposit please either:

• I have sent a cheque for $35 payable to "M Chaffer"
  
  To:
  122 Araluen Drive,
  Hardys Bay
  NSW 2257
  
  
• I have paid my $35 deposit directly into the bank account below:
  
  BSB: 062-033
  Account Name: Malcolm Chaffer
  Account Number: 2033456789
  
  

Message

Please include any other relevant information: