Registration:

Fax:       (07) 40914443  (Australia)

              +61 7 40914443 (international)

Phone:  +61 (0) 7 4091 4443

 

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Invoice/Registration Form

Please Complete, Print, and Sign then Fax or Post to:

Pacific Centre for Motivation & Change

1 Jack Street Atherton, 4883

Queensland, Australia  ABN 6460 47501 20

Program Details:      MI Online AU$350 + $35.00 GST   

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Please Fax or Post this form to us, regardless of your payment choice.

 

Pacific Centre for Motivation & Change  1 Jack Street Atherton, 4883

 

(07) 4091 4443  (Australia)    +617 4091 4443 (international)

 

Payment Options

 

1. Payment by Post:      A cheque    money order    is enclosed for AU$

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2.  Pay Pal:    Date of Payment     Amount AU$  

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3. Payment by Credit Card:  Card Type (Please tick):        Visa    Mastercard    Bankcard  

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Signature:  ......................................................................

Please also read and sign Policy Statement below:

Policy Statement  (Please read and sign below)


Registration fees must be paid in full at the time of registration. You may cancel and receive a refund minus a $25.00 cancellation processing fee up until the time that you commence Tutorial 1. No refunds will be made after you commence Tutorial 1.

 

Your password will expire twelve weeks after you commence the online learning course (in extenuating circumstances, extensions of time may be given at the discretion of the trainer)

 

In the unlikely event that the course is unavailable for an extended period of time due to technical malfunction caused by PCMC, or unavailability of the trainer then trainees will be given an equal extension of time to complete the course.

Copyrighted course materials are provided for the sole use of registered trainees and may not be reproduced or distributed without permission.


The purpose of the e-learning course is solely to provide education and training in clinical methods. The trainer shall not be held liable or responsible for the actions of trainees during the course or thereafter.

 

I have read and accept (Please tick) the terms and conditions outlined above

 

 

Signature:   ...........................................................................................

 

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