EmailMe Form - AMI 3-6 Orientation Certificate 2023, ONLINE

Name
First Last
School
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Personal Email
Phone: Daytime
Phone: Evening
Payment Options
Internet payment MMEF, ASB Bank 123048 0417212 00
Early bird registration $970 + GST ($1115.50) before Friday 21st April 2023. After 21st April $1300 + GST.
For Internet Payment include as a reference: your name and 3-6OC, e.g. OC3-6Bloggs.

For cancellations after the time of booking please refer to the refund policy on the 3-6 Orientation Course registration form.
D.O.B. (for AMI use)
MM / DD / YYYY