Registration for Reflective Clinical Practice workshop

Name (required)

Email Address (required)

What is your Postal Address?

Your Workplace is?

What is your Position?

Contact Phone Number

Please indicate whether you wish to attend the TWO DAY or ONE DAY workshop

Workshop Registration (two days)
---NZCCP Member ($150)NZCCP Student ($75)Non-NZCCP Member ($200)

OR

Workshop Registration (one day)
---NZCCP Member ($100)NZCCP Student ($50)Non-NZCCP Member ($150)

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, PO Box 24-088, Wellington, 6142

OR
Make a Direct Credit to:
NZCCP BNZ account 02-0865-0271109-005
Please reference your payment with Self Reflective Practice, and identify yourself clearly