Registration

Please Fill In All Your Details: YOU may choose to PRINT OUT THIS FORM and POST YOUR DEPOSIT
I wish to enrol in	(course title)
Date/s of course	date Amount Paid $
First Name
Last Name
Street Address
District/City
Phone Number
Email Address		Please check - is this email address correct?
Name I want printed on my certificate	(Include any initials or titles you require displayed)
Accomodation is available @ Special Price $80 per night (including linen and meals) Accommodation required? YES/NO - Arrival date / Departure date
Payment Details Golden Hill Internet Banking 115351 0040770 00
Please pay by Internet banking or send a cheque .
Internet Banking

I am posting my cheque of to

Golden Hill School, 4 Kuaka Street, Oneroa, Waiheke Island, Auckland 1081

to register for classes

Send your cheque to Golden Hill School of Healing Arts,
4 Kuaka Road, Oneroa, Waiheke Island,Auckland 1081, Phone 09 372 4166

Updated March 3, 2010 | ComStrat Design

Payment Details