Write Me A Story...
So that I can see what you mean
Understand better what to do
Organise myself, communicate and learn.
Venue: Pathways Meeting Rooms
(Upstairs Pathways Library)
1 The Corso, North Lakes
Presenters: Jane Remington-Gurney
Date: Sunday 15th August, 2010
Time: 10.00am – 4.00pm
Cost: $120 per person – ‘Early Bird Rate’
Registration Closing date: Wednesday 28th July, 2010
Discounted for people who support students who attend
Options Communication Therapy & Training Centre
Application Form
Fax, email or post this form back to us at optionsctc@iprimus.com.au
Tel/Fax: 07 3285 5522 - Address: P.O. Box 568, Kallangur, 4503 with your payment.
Name of person attending: ________________________________________________________________________
Email Address for Correspondence: _________________________________________________________________
Postal Address: __________________________________________________________________________________
Telephone/Mobile number: ________________________________________________________________________
I wish to register for the “Write Me a Story” Workshop, Sunday 15th August, 2010 and enclose my
cheque [ ] credit card details [ ] for $______________
Please note that a 2% payment processing fee will be charged for credit card payments to reflect bank fees and
charges.
Credit Card details:
Name on credit card: ____________________________________________________________________
Credit card number: ____________________________________________________________________
Date of expiry: _______________________________ Type of card: Visa / MasterCard / Bankcard
Signed: ________________________________Date:_______________________________
How to Send Your Application: Email at optionsctc@iprimus.com.au Fax on (07) 3285 5522 or post the
Registration with your payment to: - Options CTC, P.O. Box 568, Kallangur, 4503.
PLEASE DON’T LEAVE IT UNTIL THE LAST MINUTE TO GET YOUR APPLICATION IN TO US
WORKSHOP NUMBERS ARE LIMITED AND A LATE FEE WILL BE CHARGED FOR LATE REGISTRATIONS