Centre for Relationship Development: Application form to Attend a Sydney Couples Workshop

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Your Email:

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Please provide the name and email address for you and your partner. To register your partner, click the 'Add' link.

Confidential Personal Details:

First Name:

Last Name: *

Email Address:

Age

How long have you been together as a couple?

Add

Please select which workshop you wish to attend. * Saturday, 1 May 2010Saturday, 16 October 2010

What is your residential address? *

What is your partner's address? (Write 'as above' if you live together) *

Daytime telephone number:

Mobile number: *

Partner's mobile number: *

Partner's daytime telephone number:

Cost

$350 per couple

A $100 deposit is required to secure your place at the workshop date of your choice. The deposit will be deducted from the full balance.

Early Bird Discount

You can receive a $50 early bird discount off the full couple fee if the balance is paid 1 month before the workshop. The cost per couple including the early bird discount is $300.

The early bird cut-off dates are:

On or before 1/4/10 for the May workshop.

On or before 16/9/10 for October workshop.

The full balance is due 2 weeks before the workshop to secure your place.

Are you planning to pay the balance 1 month before to get the early bird discount? (We will send you a reminder) yesnodon't know

Payment Options

We have several payment options available.

Paypal- We will email you a PayPal invoice for $100 and you can pay via a credit card or your linked bank account.

Electronic Funds Bank Transfer- transfer to our account using the details below.

BSB- 012 487

Account # 500 888 704

Account name- Clinton Power

Please put your initial and surname so we can identify your payment.

Post to: Centre for Relationship Development

P O Box 762

Darlinghurst NSW 1300

Please call Clinton on 0412 241 410 and he will manually input your credit card number into our Eftpos machine.

Please tick the option you would like to use to pay your $100 deposit. Please select from below: * PaypalElectronic Funds bank TransferChequeCredit Card

What are you hoping to get from the workshop?

Do you wish to receive our monthly email newsletter "Relationship Matters" with the latest information, advice and research on relationships? (We will never share your email address. You may unsubscribe at anytime) * yesnopartner: yespartner: no

Cancellation Policy

The $100 deposit is non-refundable to cover administration costs.

If you withdraw 1 month or more before the workshop, all costs are refundable, less the $100 deposit

Withdrawals made between 1 month and 2 weeks before the workshop receive a 50% refund on the full fee.

Withdrawals less than 2 weeks before the workshop will receive no refund.

If, for any reason, the Centre for Relationship Development cancels the workshop, you will be given the choice to transfer to the next workshop date, or receive a full refund, including the deposit.

Cancellation policy is final and not negotiable. The Centre for Relationship Development regrets the difficult personal circumstances that prevent people attending including medical conditions and emergencies, severe weather or transport difficulties. Individuals unable to attend naturally experience their situation as unique and deserving of special consideration, however the logistics of event management prevents The Centre for Relationship Development from assuming responsibility for these contingencies.

We hope you can appreciate our cancellation policy.

I understand and have read the cancellation policy for the Sydney Couples Workshop. * yes

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