Way to Play Workshop 2016
(One Day)
Registration Form
Personal Details
First Name:
Surname:
Organisation name: (if applicable)
Full address:
Phone: (inc area code)
Mobile Phone:
Email address:
Ethnicity: (Collected for funding purposes)
Programme Details
Date & Location of Way to Play (click for drop down menu):
-
Refer to www.autismnz.org.nz for dates, times and locations
How did you hear about this programme?
Website
Facebook
Autism New Zealand Staff
Other
Programme Cost (per person)
Please turn over for more details and important information.
$20.00 - Family/Whānau
$75.00 - Professional
Payment Details –
GST number 64-234-382
When completed, this registration form is your tax invoice. Please keep a copy for your records.
Amount Paid:
Cheque
$
Date Paid
Please make cheques payable to ‘Autism New Zealand’
Card Number:
Visa
/
Mastercard
Name on Card:
CCV Number:
3 digit on back of card
Account details: Autism New Zealand 03 0866 0356307 01
Direct banking reference: W2P, participant surname
Expiry: i.e.00/00
Direct Banking
Please provide details of who to send the invoice to (i.e. accounts):
Name
Invoice
Physical Address
Email address
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Autism New Zealand Way to Play Registration Form Feb 2016
Way to Play Workshop 2016
(One Day)
Registration Form
Important Information
Way to Play website: The Way to Play website is an extension of the one-day workshop. Participants can continue
their journey of joyful play to support young children with autism and receive ongoing coaching and support from
our coaches. For more information, please visit www.waytoplay.co.nz
Payment: Payment must be made prior to the workshop to confirm your place. We have various payment options
available (cheque, credit card, direct banking and invoice).
Programme Cancellation Policy: Cancellations must be sent in writing, (mailed or emailed), to Autism New
Zealand. Cancellations received up to 30 days prior to the course date receive a full refund, less a 10% handling fee.
Cancellations received less than 30 days and up to seven days prior to the course will receive a 50% refund. No
refunds will be given for cancellations received within seven days of the course; however a substitute delegate may
be nominated.
Times: The programme runs from 9.30am – 3.30pm unless otherwise advised.
(Maximum number: 25 people, minimum number: 10 people).
Family/Whānau: Includes wider family members and caregivers. Students (16+ years) are also welcome.
Registration: Confirmation of your registration will be on a first-booked and paid basis.
When completed, please return with payment to Autism New Zealand: Email: [email protected],
Postal: PO Box 33481, Petone, Lower Hutt 5046 Fax: 04 803 3502, Ph: 04 803 3501. THANK YOU!
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Autism New Zealand Way to Play Registration Form Feb 2016