Tilting the Seesaw (two days) Registration Form

Autism New Zealand is thrilled to offer the Southland Region a special Tilting the Seesaw course, thanks to funds raised by Fight for Kidz 2016. Please see the reverse side of this form for more information.

Programme Details: Tilting the Seesaw, 14 and 28 September

Personal Details *indicates a required field

First Name*       Surname*      

School Name*      School’s Full Address(including postcode)*      

Position in School      Landline(including area code)       Mobile Phone      

Personal Email Address      

School’s Email Address*      

Ethnicity       Gender      

Programme Cost (per person) $20.00, Professional

Payment Details – Please select ONEGST number 64-234-382. When completed, this registration form is your tax invoice. Please keep a copy for your records.

Cheque Please make cheques payable to ‘Autism New Zealand’

Visa

Mastercard

Card Number      

Name on Card      

Expiry       CCV Number

Direct Banking

Amount Paid $      Date PaidAccount details: Autism New Zealand 03 0866 0356307 01Direct banking reference: W2P, Area of Programme, Participant Name

Invoice

Please provide details of who to send the invoice to (i.e. accounts):Name      

Physical Address      

Email Address      

How did you hear about this programme?AutismNZ Staff Website Facebook School Other (please specify)      Autism New Zealand Membership (automatic)By signing up to this programme you agree for your school to be added to the Autism New Zealand Membership.Tick here to receive email updates and further information from Autism New ZealandOther Ways to Help Please indicate if you’d like us to contact you about the following

1Autism New Zealand W2P Registration Form: Last Updated 8/05/2023Author: Morgan Ryan, Education Coordinator R:\Education\Registration Form Master Copies

Tilting the Seesaw (two days) Registration FormInformation about volunteeringInformation on making a regular donationInformation on making a bequestDonatingI would like to make a $      donation to Autism New Zealand using the payment details on the previous pageImportant InformationPayment: Payment must be made prior to the programme to confirm your place. We have various payment options available (cheque, credit card, direct banking and invoice), please only select one. Invoices will be sent at any time after the registration form has been received, and need to be paid one week before the course, if not earlier. Credit card payments will be processed one – two weeks before the course. Receipts will not be sent unless requested.Programme Cancellation Policy: Cancellations must be sent in writing, (mailed or emailed), to Autism New Zealand. Cancellations received up to 30 days prior to the course date receive a full refund, less a 10% handling fee. Cancellations received less than 30 days and up to seven days prior to the course will receive a 50% refund. No refunds will be given for cancellations received within seven days of the course; however a substitute delegate may be nominated.

Times: The programme runs from 9.30am – 3.30pm both days.

Registration: Confirmation of your registration will be on a first-booked and paid basis.

Confirmation: Participants will receive an email response acknowledging the receipt of their form at the time it is read. Forms not sent through email may not receive an acknowledgement. All participants will receive a confirmation/reminder email around two weeks prior to the programme starting. If no email address is provided we cannot confirm you will receive a reminder.Autism New Zealand reserves the right to change, postpone, or cancel our education programmes at our discretion. Registered participants will be notified by email as soon as possible.Maximum participants (can be changed at Autism New Zealand’s discretion): 15 Minimum participants (programme subject to postponement or cancellation if not reached): 10

When completed, please return with payment to Autism New Zealand, National Office

Email: training@autismnz.org.nz (preferred)Postal: PO Box 33481, Petone, Lower Hutt 5046 Fax: 04 803 3502, Ph: 04 803 3501Website: http://www.autismnz.org.nz

Please check the website for contact details of your local Autism New Zealand Branch

2Autism New Zealand W2P Registration Form: Last Updated 8/05/2023Author: Morgan Ryan, Education Coordinator R:\Education\Registration Form Master Copies