asist-registration-form-2014

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Windermere Child & Family Services 48 Webb Street, Narre Warren, VIC 3805 ABN 63 066 828 936

Applied Suicide Intervention Skills Training (ASIST) Presented by 2 accredited facilitators.

Dates.

Small groups increase opportunities for discussion and skills practice.

26/27 February 2014 28/29 May 2014

Cost.

Attendance at both days is essential

$350 per person (inc GST). This includes Resources, Morning, Afternoon Tea & Lunch. Thanks to community donations, a limited number of heavily subsidised places may be available. Contact us for more information.

27/28 August 2014 25/26 November 2014

Time. 09:00am - 05:00pm

Place. Windermere, 48 Webb St, Narre Warren

For more information. Contact Gen Dawson on (03) 5995 4655

Please note. A separate registration form is required for each person attending the training.

To register or for more information. Return the form below by COB one week prior to training date. By email : By phone : By fax : By mail :

Payment option.

gen.dawson@windermere.org.au (03) 5995 4655 (03) 5995 4688 48 Webb St, Narre Warren, VIC 3805

Your details.

Amount:

Your name:

Organisation:

Cheque (payable to ‘Windermere’)

Direct deposit ‘ASIST TRAINING - YOUR NAME’ for transaction reference. (BSB: 083-214 ; A/C: 518 358 277)

Position: Postal Address:

Credit Card

Visa

Card No:

Exp:

Name on Card:

Amount: $

Signature:

Mastercard Email: Phone:

/

Office Use Only: Code 475.88.2021

Special Dietary or Other needs:

THIS REGISTRATION FORM BECOMES A TAX INVOICE/RECEIPT ONCE PAID CFC0044


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