Fax Form

 

A receipt will be issued upon receipt of payment:

 

 

Yes, I will attend course __________________________________________________

 

Date  ________________________________  Time:  __________________________

 

 

First Name:____________________________________________________________

Last Name:____________________________________________________________

Company:_____________________________________________________________

Address:______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

 

Phone:__________________________  Fax:_________________________________

Mobile:__________________________  Email:_______________________________

 

Payment Details:  Dobbs International Limited  (GST No 62-564-784)

Bank Direct  - 12-3174-0292705-000

Cheque:        PO Box 39315, Wellington Mail Centre, Wellington 5045

All registrations are confirmed in writing before the course commences and upon receipt of full payment.