Moving with Life Healesville Registration & Payment Form

 

Yes No I have completed two or more days NVC training with a certified trainer.

 

YOUR CONTACT DETAILS
EMERGENCY CONTACT DETAILS
YOUR ACCOMODATION

Linen (byo or hire) @ $10 per person: sets

Preferred person to share a room with?

Any other requests, or information you’d like to share, in relation to yours or others accommodation/sleeping/rest needs? eg. early riser, early to bed, light sleeper, snorer.

YOUR DIETARY NEEDS

All food on the retreat will be wholesome vegetarian prepared by an experienced and caring retreat caterer. Meals will be provided at set times, beverages and filtered water will be available on a self-serve basis throughout the retreat.

Please select one or more of the following to indicate your dietary preference:

  • Vegetarian
  • Vegan
  • Gluten-free
  • Dairy-free

If you have any special dietary needs or serious allergies then please state them below.

WELLBEING NEEDS

Is there anything else you would like us to know about (e.g. health condition, allergies, disability) in order to support your wellbeing and full participation at the retreat? Please outline and/or make specific requests below:

If you have a current medical or first aid qualification and would be willing to assist in an emergency please indicate your qualification:

TRANSPORT

We are working with different options to support participants in getting to the retreats. Once you have registered we will email you links to join a Google Group of registered participants for the purpose of arranging car-pooling, as well as information on other transport options.
I would like a lift from:
I can offer a lift to people from
Other (please indicate)

PAYMENT

Credit Card payments can be made via PayPal - without or without a PayPal account.

PAYMENT FEES FOR Healesville RETREAT Please select one or more:

  • Concession   -   $795
  • Full Payment   -  $950
  • I am approved for a scholarship, and will pay a total of: $.00 (minimum $650)
  • Scholarship deposit:      $.00   -   Balance owing if paying deposit =

Select Payment Option (credit card payments can be made via PayPal)

  • Pay by PayPal (incurs a 2.8 % surcharge = $)
  • Pay by Direct Deposit (Australia only)
  • Pay by Overseas Bank Transfer (+ $12 for our bank's fee + your bank's fees)

Order Details for Moving with Life Healesville:
Tuition and Accommodation: ? = AU$0
Linen: x 0 = AU$0
Pay Deposit: no
PayPal Fee: AU$0
OS TT Fee: AU$0

Total to Pay now = AU$

Please NOTE, this payment is to be made in Australian dollars (AU)

Direct Deposit Instructions

Whilst the preference is for registrants to use PayPal, if you wish to deposit funds direct to our bank account:
A/C Name: NVC Melbourne
BSB: 633000
A/C: 158489617
SWIFT Code: BENDAU3B (for overseas bank transfers)

Bank Address: Bendigo Bank, 91 Maroondah Highway, Ringwood, VIC, Australia 3134

Description: Please put into the Description or Narrative section of your Direct Deposit, your name or initials & "MWL" (for example CScott_MWL)

If paying by Electronic Funds Transfer or Direct Deposit for Healesville Retreat, please email Andrew (toastmasterandrew@gmail.com) with your name, date money deposited or transferred, and the amount.

Receipts will be issued after funds have been cleared in our bank account.

Thank you :)

TERMS & CONDITIONS

Full refunds of retreat fees can be made up to 21st April 2017, minus 10% admin fee, if you need to cancel your retreat booking.
After 21st April we can refund your fees, minus 10% admin fee, if your place can be filled.

Please select: I have read and accept the Terms & Conditions (required)