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Fascial Manipulation
Course Registration Form
December 2014
AIAT
PO Box 5032
Kingsdene NSW 2118
Fax: +61 (0)2 8456 6003
[email protected]
www.aiat.com.au
Level 1 or Level 2
Please print out this form and either mail or fax it back to the AIAT with your payment.
You will receive an email within three days of receipt of this registration form. If you have not heard from us at the
AIAT by that time, please contact us.
Refund and Cancellation Policies
Cancellations by registrants must be submitted in writing. The following cancellation fees apply:
More than 42 days (6 weeks): Monies returned less a $110 administrative fee.
Between 21 days and 42 days (3 weeks and 6 weeks): 50% of the course cost.
Less than 21 days (3 weeks): No refunds will be made. Seminar fee may be transferred to another person for the same dates.
Whilst endeavouring to avoid any inconvenience, the Australian Institute of Advanced Training reserves the right to cancel or
reschedule this seminar. Under these circumstances, seminar fees will be returned in full to the registrant.
Please note that the Australian Institute of Advanced Training is not responsible for any other associated expenses.
Registration Details
Mr/Ms/Mrs ......................................................................
First Name
Profession ........................................................
Surname
Eg. Physio, Chiro, OT, Massage Therapist etc
Address ...............................................................................................................................................................
Suburb ............................................................
State ............................
Post Code ....................................
Mobile .......................................... Phone .............................................. Fax ............................................
Email address .....................................................................................................................................................
Payment Details
Sydney Level 1 – 1,2,3,5,6,7 December 2014 (all 6 days)


AUD$1,980 (incl GST)
Sydney Level 2 – 9,10,12,13,14,15 December 2014 (all 6 days)
AUD$1,980 (incl GST)
The above prices are the Early Bird rate and only apply for registrations received by 17th October 2014
Payment Method:
 VISA
 MasterCard
 Bankcard
 Cheque
Amount: ..........................
Credit Card Number: ............................................................................................... Exp Date: ........ / .........
Card Holder’s Name: ........................................................................................................................................
Signature: ..................................................................................
I authorise the Australian Institute of Advanced Training to charge my credit card for the amount listed above.
Cheques are to be made payable to Australian Institute of Advanced Training and sent to the address above.
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