Actor Centred Evaluation and Design Workshop.                         Registration Form.  

Facilitated by Jeph Mathias and Rory Jones
Christchurch, April 4-6 2023.
Email *
Name *
e-Mail *
Organisation
Job Title and 1-2 sentence description about your role *
Why Are You Interested in this Workshop? Write a Few Sentences. . *
These Workshop Themes Most Interest Me (select up to three)  *
Required
Is There Something Else You Would Like Us to Cover?
A simple Lunch, Morning and Afternoon Tea are provided. In recognition of the environmental crisis all food will be vegetarian. Please indicate any other dietary requirements. 
 
 *
Required
Please elaborate on any dietary requests if you need to
Is there anything else you want to add. 
Clicking the submit button completes your registration.  You may either deposit your fee in the account given below and we will send you a receipt and confirmation of registration or simply submit your registration and we will send an invoice to the given e-mail. Your registration will be confirmed  when your fee is processed.  *
Fee:   Before March 1, 2023 NZ$ 980 + GST NZ$ 147 = NZ$ 1127
          After March 1 2023 NZ$ 1200 + GST NZ$ 180 = NZ$1380* 
10% Group Registration Discount for 3 or more participants from one organisation registering together. Your invoice will include 10% discounted from the total cost. 

When you register you will receive an invoice for your fee and receive a receipt, confirmation of registration and welcome pack when it is processed. Alternatively you may deposit your workshop fee, tagged with your name in this account. You will receive a confirmation or registration, a receipt and welcome pack as soon as it is processed.

Account  Number: 12-3409-0009389-03
Account Name: Unpredictable
Accounts Holder's name:  MR J M MATHIAS AND DR K R MATHIAS (use this in the account name field)
Bank: Auckland Savings Bank, PO BOX 35, Auckland 1015, New Zealand. SWIFT CODE ASBBNZ2A

*Refund Policy: If you withdraw before March 20 you  will receive a full refund. After March 20 you will be refunded minus NZ$ 150.  Should the workshop not proceed for any unforeseen reason your registration fee will be fully refunded.  
Thank you for registering for our 2023 Actor Centred Development workshop. When we get your completed registration form and fee we will mail you a receipt and a welcome pack.

We look forward to getting to know you in Christchurch.
                                                                                                          Jeph Mathias and Rory Jones.  
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