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Birthspirit’s Mind, Body, and Spirit Workshop 13th - 19th January 2013 - Postal Registration Form
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Please
print this form, complete it, enclose a cheque for $1,500.00 made out
to Birthspirit Ltd., and post to:
Birthspirit, 15 Te Awa Road,
R.D. 3, Hamilton 3283, New Zealand.
Please
register me for Birthspirit's Mind, Body and Spirit Workshop 13th - 19th January 2013
Accommodation needed
(please circle one)
Yes /
No
Please
circle one: Employed /
Self employed
Name:
........................................................................................
Address: .........................................................................................
........................................................................................
........................................................................................
Email: .........................................................................................
Phone: ........................................................................................
Midwifery
Council Registration No. ......................................................
Tell
us a little bit about yourself - up to 150 words:
If you wish to contact someone about the Workshop please phone Maggie Banks on 07
856 4612 or email at maggiebanks@birthspirit.co.nz
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