Registration form
  for Professional Training in
  Cognitive Behaviour Therapy

Please follow the numbered instructions & complete form legibly

   1   Ensure you have read the refund policy.

 2   Insert cost alongside event(s) for
which you are registering 

  ▼

 3  ▼   

If more than one venue, circle the number under your choice

TOTAL: $

NB: GST of 15% is already included
in all fees  (GST# 36-715-731)

  □ Cheque enclosed (payable to Rational Training Resources)

  □ $ ....................... credited to Rational Training Resources bank account on ........ / ........ / ........
                                    (A/c no: 060738-0070427-00)

  □ Please charge credit card as below (form may be posted, or faxed to 64-6-870 9964):

         Card No: __ __ __ __  /  __ __ __ __  /  __ __ __ __  /  __ __ __ __    VISA / MASTERCARD (circle).

         Name on Card (block letters): ________________________________  Expiry Date : __ __ /__ __ 

         Amount: $ _________________ Cardholder’s Signature: _________________________________  

  Post: PO Box 2292, Stortford Lodge, Hastings, New Zealand 4153     Fax: 64-6-870 9964     E-mail: training@rational.org.nz