Registration form
for Professional Training in Cognitive Behaviour Therapy

u	Please ensure you have read the refund policy. Please complete form legibly
v	Insert cost alongside event(s) for which you are registering		q	w q	circle number under relevant venue
				Dunedin	N.Plymouth	Tauranga	Hastings
	Primary Cert. REBT	$965		0801DN	0801NP	0801TG
	WS: Chge Dysfunct. Beliefs	$165		0802DN	0802NP	0802TG
	WS: Generalised Anxiety	$165		0803DN	0803NP	0803TG
	WS: Children & Families	$145		0804DN
	WS: Chron. Illness/Disab.	$155				0805TG
	WS: Primary Health Pract.	$145					0806HB
	WS: Weight Management	$145					0807HB
	WS: Mindfulness	$155					0808HB
	WS: Emotion Regulation	$155					0809HB

	TOTAL enclosed: $			NB: GST of 12.5% is already included in all fees (GST# 36-715-731)

x	Complete Payment Details:		q
□	Cheque (payable to ‘Rational Training Resources’) enclosed. (Post form to: PO Box 2292, Stortford Lodge, Hastings, New Zealand)				If you would prefer to pay by direct bank transfer, please contact the Centre
□	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 on Card: __ __ /__ __ Amount: $ _________________ Cardholder’s Signature: _____________________________________