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Registration Form

Register now for the course starting 9th February 2011

Early Bird registration: $140 if paid no later than 2 weeks prior to commencement.

Please fill in all mandatory (*) fields below.

	First name	Surname	Age
Registrant 1 *
	First name	Surname	Age
Registrant 2 *
Address 1 *
Address 2
Suburb *		Postcode *
	Home	Mobile
Phone *
Email *
Confirm Email *
How did you find out about the Marriage Course? *
How long have you been married/ in a relationship? *
Do you belong to a church? If so, which one?
Do you have any food allergies?
Method of payment *	Cheque Internet Transfer	$160 (or $140 Early bird)
	Cheques payable to: Philip Taylor PO Box 91, Croydon NSW 2132	Internet Transfer to: Philip Taylor A/c No. 890026 B.S.B. 032260
Please enter this antispam code: *	Please type the text from the image to enable this form to be submitted. It is case sensitive.

 

Your registration will be completed on receipt of payment. You will receive an email confirmation of your registration details.