New Customer Registration Form

The Lift to Literacy Competency with Dr Pam Kastner, 2022. Registration form.
Full Name *

First Name Last Name
School/Place of work *

Address

Suburb City/Town

Postal Code Country
Workshop you wish to attend.
Phone Number *

Area Code Phone Number
E-mail
How did you hear about us? *
Other *
Do you have any dietary requirements?
Anything else we should know?
I wish to book;

Late fee (pay before workshop date) NZD$175 Tertiary Student fee (Book and pay before workshop NZD$100)
Should be Empty:

The Lift to Literacy Competency with Dr Pam Kastner, 2022. Registration form.