Register for a Seminar

Fill in the form below to register for an upcoming course or seminar. Required fields are marked *.

If you would like to be emailed about upcoming seminars please click here

Personal Details
* First Name:
* Last Name:
Billing Address
Organisation:
Address:
Suburb:
City/Town:
Postcode:
Country:
Contact Information
This information will only be used to contact you regarding your payment, if necessary.
* Email Address:
Phone Number:
Facsimile:
Seminar Details
Upcoming Seminars:	1. Autism Awareness Day 2nd April 2012 - Auckland 2. Autism Awareness Day 2nd April 2012 - Wellington 3. Autism Awareness Day 2nd April 2012 - Christchurch 4. Autism Awareness Day 3rd April 2012 - Dunedin
* Which Seminar will you attend:	Autism Awareness Day - Auckland 2nd April Autism Awareness Day - Wellington 2nd April Autism Awareness Day - Christchurch 2nd April Autism Awareness Day - Dunedin 3nd April
* How many tickets would you like to book:	1 2 3 4 5
* Registration Fee (please select):	$25.00 Auckland or Wellington $30.00 Christchurch or Dunedin
* Payment Type:	Credit Card Bank Deposit Cheque
Security code
* Please enter the letters that appear in the image:

You will receive confirmation of your registration once we have received your payment.

If paying by credit card please have your card details available as you will be asked for these at the next screen.

If paying by direct credit please transfer funds to Autism New Zealand Inc. 03 0866 0356307 01 using the reference WAAD and ensure your name appears as it does on this registration form.

If paying by cheque please make payable to Autism New Zealand Inc. and post to
PO Box 12599 Thorndon Wellington 6144.