Register Embedding Sensory Modulation in Occupational Therapy Practice 2020 (Knowledge Bite Series) Please fill in the form below to register for this course. Your Name* First Last Your Place Of Work* Type Of Work* Your Email Address For Us To Communicate With* Contact Phone Number* Your mobile phone is preferredYour Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please Read The Terms And Conditions* To secure your place on the course please pay the full course fee with this application. If you are paying electronically please make this clear in your application and please state your name in the bank payment reference. If your organisation is paying please ensure that they state your name in the bank payment reference so that this can be matched to your application form. Please be respectfully advised that we are unable to process an Application without the above happening and will defer offering a place until payment is received. A receipt will be sent to you electronically once the full course fee is paid. If you require an invoice please contact us to request this. Places will be allocated on a first come basis on receipt of this form with the full course fee. Electronic Payments Payments should be made to: Chameleon Courses Account: BNZ 02-0272-0207005-025 Please ensure you state: Your Name Course Code: SMKB20 The Amount Paid This will allow us to clearly identify you on the bank statement. Fees Refund Policy The full course fee is non-refundable 10 (ten) working days prior to the course commencement date via email notification, and if you cannot attend you may send another occupational therapist in your place. Please let us know by email if this is the case. Please note refunds are less 15% of the full course fee when email notification is received in advance of the non-refundable cut-off. Cancellation of Course and/or Change of Dates If, for reasons beyond the control of Chameleon Courses, the course is cancelled, registration fees will be refunded less a 15% deduction for expenses incurred. If, for reasons beyond the control of Chameleon Courses, the course dates are shifted leading to a participant being unable to attend on the new dates, registration fees will be refunded in full. No other liability for costs incurred by the participant will be attributed to Chameleon Courses. NB. This course will be cancelled if sufficient numbers are not reached by 1st October 2020. Liability In the event of any disruption and/or event leading to losses or added expenses being incurred by a participant in respect of the course, there shall be no liability attached to Chameleon Courses. The course outline and content is accurate at time of print however, Chameleon Courses reserves the right to amend any component as necessary. By submitting this form you are agreeing to these terms and conditions. Chameleon Course looks forwards to hosting you on this course 🙂 I agree to the Terms and Conditions Please select your dietary choice by ticking one of the below options:* Standard Vegetarian Gluten Free Step 1 : Register for: Embedding Sensory Modulation In Occupational Therapy Practice* $375.00 Early Bird Fee till 28th October 2020 All amounts in $NZ and includes GST.Step 2: Select Your Payment Method* Direct Deposit Banking Credit Card via Stripe (you do not need a Stripe account) Our Bank Details are: Bank: BNZ Account Name: Chameleon Courses Account Number: 02-0272-0207005-25 Important: Please pay your funds within three days of registering with this form. When depositing, state your Name and the Course Code WHRI/2019 as the reference, and send an email to firstname.lastname@example.org to let us know that the payment has been made.Credit CardCard Details Cardholder Name Please subscribe Me To The Chameleon Courses Mailing List Any Comments Or QueriesI consent to my submitted data being collected and stored* I agree Total To Be Paid $ 0.00 NameThis field is for validation purposes and should be left unchanged.