EMDR workshop registration

Name (required)

Email Address (required)

What is your Postal Address?

Your Workplace is?

What is your Position?

Contact Phone Number

Please register me for the workshop as

Workshop Registration (18 - 20 January)

When you click submit, you will be sent an email with a confirmation of your registration. Then, if applicable please either

Post your cheque made out to NZCCP to:
NZCCP Canterbury Branch, PO Box 24-088, Wellington, 6142

OR
Make a Direct Credit to:
NZCCP BNZ account 02-0865-0271109-000
Please reference your payment with EMDR Workshop, Christchurch, and identify yourself clearly