Stroke CARE :: Hamilton :: July 2017
Course Booking Form - Waikato Diocesan School - Tuesday 11th July
Email address *
Your Name *
Your answer
Name of workplace / employer (or family carer) *
Your answer
Address *
Your answer
Mobile number *
Your answer
Your Role *
Do you have any special requirements? (e.g. dietary, accessibility...)
Your answer
Terms: *
Required
Terms and conditions of booking:
REFUNDS: No refunds will be given for cancellations due to course organisation costs incurred. Substitution of participants is acceptable at any time prior to the course commencing - please inform tutor by email.
Course fees payable (Earlybird closed 23 June): *
Payment of course fees *
Employer contact details if invoicing employer
Your answer
How did you hear about this course?
Any questions or comments?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms