Please Send Registration To: Post: PO Box 337, Lutwyche, QLD 4030 Fax: +61 (0)73357 5169
Brisbane, 15 - 17 March 2014, International Workshop Registration Form
SEE POSTER FOR ADDRESS AND TIMES OF WORKSHOP. Please register by 28 February 2014
Please send registration to: Post: PO Box 337, Lutwyche, QLD 4030 Fax: +61 (0)73357 5169
Email:
Workshop15 – 17 March. Three-dayTaoist Tai Chi™ workshop: AUD $350
No daily rates15 – 16 March. Weekend onlyTaoist Tai Chi™ workshop: AUD $240
Meals3 day meals package (all 3 lunches, 2 dinners) AUD $115
Weekend only meals package (2 lunches, 1 dinner) AUD $69
OR
Lunchesonly AUD $22each Saturday Sunday Monday
Evening Meals AUD $25 each Saturday Sunday
Name Mr. Ms......
AddressNumber and Street ......
City ...... State ...... Postcode ...... Country ......
TelephoneHome ...... Mobile ...... ……. Fax ......
E-mail & DOBE-mail ...... print clearly Date of Birth ......
ClubBranch...... Region ...... Country (if o’seas) ...... Instructor
Health ConcernsDo you have any health problems or special requirements?
If you have any food sensitivities or allergies you are advisedto make your ownfood arrangements. Vegetarian options if requested will be provided but other food requests cannot necessarily be catered for.
......
EmergencyContact name ...... Telephone ......
TravelArrival date ...... Flight ...... Time ......
From (City of departure, or last connection)……………….…………………….
Departure date ...... Flight ...... Time ......
Airport transport required? At arrival: Yes No At departure: Yes No
Accommodation Billet Motel Not required
Please tick one of the above. (Note: for billet requests, a minimum of 4 weeks notice is required.)
Please read and sign: I accept that the Taoist Tai Chi Society of Australia Inc and the local branch hosting the workshop are not responsible for any loss or damage to my personal property, or for any personal injury sustained. I undertake not to teach Taoist Tai Chi™ internal arts without the express consent of the National Instruction Coordination Committee of the Taoist Tai Chi Society of Australia Inc. I agree to abide by the by-laws and constitution of the Taoist Tai Chi Society of Australia Inc.
Signature...... Date ......
AMOUNT OWING: Workshop fee: $ ………...... Meals package: $ ……… Total due: $…......
HOW TO PAY: Please pay at the Brisbane branchby one of the following methods (tick one):
CHEQUE BY POST. I enclose a cheque for $...... Please mail with this form to TTCSA Brisbane Branch, PO Box 337, Lutwyche, QLD 4030. Make cheques to: Taoist Tai Chi Society of AustraliaDIRECT DEPOSIT. I have paid the total amount owing by Direct Deposit to: BSB 066 107 Bank Acct No: 009 40083 Using Reference Number: IWBRMAR(include your name in the Ref Number field). Date of payment: ……/……../……
CASH OR CHEQUE IN PERSON. I will pay in person at the Brisbane Branch on or before 16 March (please do not pay at any other local branch).
Office use only...... Amt received $………..Date……….TX no…..…..…..DD………….Amt outstanding $......
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