Register now for an upcoming workshop

This form may be used to register to any of our upcoming workshops and seminars. On receipt of your registration, we will contact you to obtain your payment details and send you additional information. If you prefer to fax us your registration, please download and print out our Word registration form or PDF registration form. Adobe Reader is required in order to access PDF documents.

Terms and conditions

• As space is limited to small groups, a 50% deposit is required in order to confirm your space
• Participants who are unable to attend may nominate a substitute at any time
• Any cancellations received 5 working days or less prior to the workshop commencement date, are subject to the full workshop fee
• Participants will receive a formal confirmation with venue details at least 2 weeks prior to the workshop commencement date

Please note that items marked with an asterisk *
are required in order for this registration form to be processed correctly.

Participant(s) details

Contact name:*
Job Title:*
Business name:*
Street Address:*
City:*
State:*
Post code:*
Telephone:*
Mobile phone:
Fax:
Email:*
Number of participants:
Participant names:
Workshop interested in:
Additional comments:
	Please type-in above authentication code in space provided below.

Payment details

We accept payments via VISA, MasterCard, Bankcard or cheque.

• Credit card payments: If you chose to pay via credit card, we will call you to obtain your credit card details by phone. Please do not send us your credit card details in an email.
• Cheque payments: If you chose to pay via cheque, please make your cheque payable to
  "W C Chiu Pty Ltd" and post your cheque to our Perth office (address below).

Your preferred method of payment: VISA MasterCard Cheque

I have read, understand and accept Peggy Chiu Coaching's Terms and Conditions above.