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Personal Details
Title
First Name
Last Name
Email Address
Address
Suburb
State
Postcode
Country
Phone
How did you hear about this event?
Professional Details
What is your occupation?
Which organisation do you work for?
Please describe your professional practice/work experience including type and number of years.
Do you have a grounding in any form of somatic practice/approach or have you taken any somatic based training? Please describe type, level and current experience.
Dietary Requirements
Special Dietary Requirements
Vegetarian Plus Fish (Pescatarian)
Vegetarian (No Fish)
Gluten Free
Dairy Free
Other (Please specify)
Payment Options
Earlybird $1,100
Initial deposit of $330 due within 7 days with full payment of $1,100 due by 18th February 2019
Earlybird Payment Plan $1,177
First instalment due in month of enrolment, followed by regular monthly instalments with the full balance due by 1st April 2019. Please advise your preference for the no. of instalments in the comments box below.
Payment Method
Pay by Bank Transfer
Pay by Credit Card - fee of 1.75% applies (2.9% for overseas cards)
Information on how to pay will be detailed in your enrolment confirmation email.
Comments and Queries
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