Enrolment/Registration Form

This form is for individuals wanting to enrol in fee-paying workshops and leadership programmes. Please note for DHB contracted workshops, please complete the registration form in the regional calendars.

Please fill in the form below, or if you prefer, download this form (PDF) to print and mail/fax to us.

If you don't have Adobe Acrobat Reader, you can download it here.

First Name*

Last Name*

Organisation

Role

Address*

Billing Address (If invoice)

Phone (home)

Phone (work)*

Cellphone

Special Requirements (dietary, access)

Course Enrolment

Course	Fee

Total:

Have you previously enrolled in a course with us?

Yes No

I understand that my enrolment still requires confirmation from Blueprint for Learning.

Privacy Act
Under the Privacy Principles you have the right of access to all personal information held about you.
You also have the right to ask Blueprint for Learning to correct any information which is inaccurate.
You can exercise those rights by applying to the Chief Executive Officer.

Fee Payment Options

Cash Cheque Internet Banking Credit Card Payment On Invoice

If someone else is paying for your attendance please provide their information in the Billing Address details. The invoice must be paid before the workshop date or as arranged.

Refunds

Fees are fully refunded if the workshop is full or fails to start.

100% refund less $15 (NZD) admin fee for withdrawals received six - 10 working days before workshop starts.
Refund applications must be received five working days before workshop date.
50% refund less $15 (NZD) admin fee for withdrawals five - one working days before the workshop starts.
Applications must be received before workshop date.
No refund for non attendance on day.

Refunds can be negotiated as an exception with Chief Executive.

Last updated 12:31:50 pm Thursday 8 October, 2009