Kinway

Relationship Counselling

Relationship Education Calendar

Professional Development Training Programs

Rural Services

Family Court/Separation Programs

Registration Form

Locations

Employee Assistance Services

REGISTRATION FORM

To ensure your place

please register not less than one week

prior to the starting date.

Workshop_date:..............................................................

Course_name:.................................................................

Name:............................................................................

Address:.........................................................................

................................................Postcode:.......................

Phone_Work............................Home............................

Email:.............................................................................

How did you hear about our course?

.......................................................................................

.......................................................................................

Enclosed please find my cheque/postal order

 Please make cheques payable to:  

Anglicare WA - KinWay,

PO Box C138 , East Perth WA 6839

Or please bill my:

¦ Mastercard ¦ Visacard ¦ Bankcard

For $.....................

Name on card:................................................................

Card no :             /       /       /

Expiry date:          /      

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

Please add me to your mailing list:          YES / NO

For further information or to book please phone

9263 2050 or email kinway.perth@anglicarewa.org.au