Fascial Manipulation Course Registration Form December 2014 AIAT PO Box 5032 Kingsdene NSW 2118 Fax: +61 (0)2 8456 6003 [email protected] www.aiat.com.au Level 1 or Level 2 Please print out this form and either mail or fax it back to the AIAT with your payment. You will receive an email within three days of receipt of this registration form. If you have not heard from us at the AIAT by that time, please contact us. Refund and Cancellation Policies Cancellations by registrants must be submitted in writing. The following cancellation fees apply: More than 42 days (6 weeks): Monies returned less a $110 administrative fee. Between 21 days and 42 days (3 weeks and 6 weeks): 50% of the course cost. Less than 21 days (3 weeks): No refunds will be made. Seminar fee may be transferred to another person for the same dates. Whilst endeavouring to avoid any inconvenience, the Australian Institute of Advanced Training reserves the right to cancel or reschedule this seminar. Under these circumstances, seminar fees will be returned in full to the registrant. Please note that the Australian Institute of Advanced Training is not responsible for any other associated expenses. Registration Details Mr/Ms/Mrs ...................................................................... First Name Profession ........................................................ Surname Eg. Physio, Chiro, OT, Massage Therapist etc Address ............................................................................................................................................................... Suburb ............................................................ State ............................ Post Code .................................... Mobile .......................................... Phone .............................................. Fax ............................................ Email address ..................................................................................................................................................... Payment Details Sydney Level 1 – 1,2,3,5,6,7 December 2014 (all 6 days)   AUD$1,980 (incl GST) Sydney Level 2 – 9,10,12,13,14,15 December 2014 (all 6 days) AUD$1,980 (incl GST) The above prices are the Early Bird rate and only apply for registrations received by 17th October 2014 Payment Method:  VISA  MasterCard  Bankcard  Cheque Amount: .......................... Credit Card Number: ............................................................................................... Exp Date: ........ / ......... Card Holder’s Name: ........................................................................................................................................ Signature: .................................................................................. I authorise the Australian Institute of Advanced Training to charge my credit card for the amount listed above. Cheques are to be made payable to Australian Institute of Advanced Training and sent to the address above.