EmailMe Form - AMI Assistant Certificate Course (Birth to 3)

Name

First Last

School

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone: Daytime

Phone: Evening

Personal Email

Payment Options

Internet payment MMEF, ASB Bank 123048 0417212 00

50% payment option- $560 paid by Feb. 12th 2016, remaining fees by March 31st 2016.

Cheque payable to MMEF. Post to MMEF, PO Box 108054, Symonds Street, Auckland

For Internet Payment include as a reference: your name, your school, and "AC 0-3".

Early Bird Registration $975+ GST
(to be eligible for Early Bird Registration, registration and payments must be received by Friday February 12, 2016)

Late Registration (after February 12) $1125 + GST
There can be no refunds after March 1, 2016