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Public Talk Registration Form
Please enter your contact details
First Name
Last Name
Spouse Name
Company
Street
City
State Postcode
Country
Email
Phone Fax


Please indicate your area of expertise
All quotes in NZ currency unless specified otherwise
Parent Guardian Osteopath General Practitioner
Paediatrician Chiropractor Health Worker
Nutrition Kinesiology Language/Literacy
Cranial Sacral Neurodevelopment Naturopath
Other (Please specify)


Where did you hear about the our events?
E-flyer Print flyer Print ad Radio Friend Practitioner
Other (Please specify)


Donation
ADD/ADHD/ASD, Dyspraxia and other neurodevelopmental disorders.
$15 Healthy Cells Expo $20 Public Talk
Total Fee: AUD$

Please click here for permission to print your name as a sponsor
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Payment By Direct Debit (our preferred method):

Name: Mindd Foundation
BSB: 032 058
Account: 195572
Please send an email with transaction number to confirm payment to admin@mindd.org

By cheque



Mindd Registration
PO Box 151
Vaucluse NSW 2030
Please include registration form.
Payment By Credit Card


Click register below for secure online payment with paymate with Master Card or Visa

Refund Policy
For cancellations, please send written notice to info@mindd.org or the above PO Box (no fax). For notices received one week prior to event, your registration fee will be refunded less 25% cancellation charge. No credits will be given for late notice or “no shows”.

I agree with all the terms and conditions outlined above
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You will be forwarded to the paymate site for online payment.



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