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REGISTRATION FORM FOR THE C.A.T.

CONFERENCE

CREATIVITY ART & THERAPY

BALI 2011

PERSONAL INFORMATION

NAME: SURNAME:

PASSPORT #: ADDRESS:

CITY & STATE: COUNTRY:

PHONE CONTACT: CONTACTO OF A RELATIVE OR FRIEND:


*Include Intl. code *In case of emergency.

EMAIL: YOUR WEB PAGE:

YOUR PROFESION NOW:

Signature:

Date:

* You may fill out this form and sign and then scan it to email it to us.

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Application/Registration

To participate in the C.A.T. Conference BALI 2011

NAME OF PARTICIPANT …………………………………………………………………………………………………….

Reservation will be in effect after a fee is paid either in part (50%) or in full in accordance
with the rules of the conference.

SIGNATURE:

DATE:

* You may fill out this form and sign and then scan it to email it to us.

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FEES TO PARTICIPARE IN THE C.A.T. CONFERENCE – BALI 2011

Please place an X in the box below.

GENERAL PUBLIC ATTENDING– FULL FEE - $ 1,020.00 AUD.

GENERAL PUBLIC ATTENDING – PART FEE - $ 1,020.00 AUD

First payment before 30th of December 2010 of 50 %.

Second payment before 15th of January 2011 of 50% .

GENERAL PUBLIC – FULL FEE $ 1,160.00 AUD.

If payment is made AFTER 30th of December 2010

*PROFESSIONAL WHO WANTS TO OFFER A WORKSHOP – FULL FEE $ 880.00 AUD.

* This is a fee after receiving a confirmation of acceptance of the proposed workshop.

* The professional presenter registering for the conference and wanting to present a workshop MUST have an
email confirmation from the organizers. There are only 6 places to present a workshop and as soon as they are
filled, we shall inform the rest of applicants.

* All prices are per person.

* If in the case of an emergency you will need to cancel your participation in the conference, the organizers will
refund 50% of the total fee (no matter in what category you have registered). No refund will be given if you have
only deposited 50% of the total fee. The funds will be needed to pay for the advanced reservation of the
accommodation.

* If you plan to come with your family, please ask for details by emailing us for available places.

FOR MORE INFORMATION PLEASE CONTACT THE ORGANIZING TEAM: Gestaltarttherapycentre@gmail.com

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YOU CAN PAY USING:

BANK TRANSFERENCE

PAYPAL –VISA

WESTERN UNION

PLEASE ASK US FOR THE ON LINE BANK DEPOSIT DETAILS

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