Register Online Please read the form carefully and complete all the required fields Select your accommodationSelect your accommodation option*Cabin, comfortable 4 share 2 full bathroomsHotel, twin share with ensuite (limited number book early)Single HotelNon-residential optionCabin, comfortable 4 share with two full bathrooms*Deposit only (by 30 August 2017) Admin code D1Early Bird Full Price ($2495)Hotel, twin share with ensuite, limited number available - book early*Deposit only (by 30 August 2017) Admin Code D2Early Bird Full Price ($2745)Single Hotel, please contact our admin for information regarding single rooms*Deposit only (by 30 August 2017) Admin code D3Early Bird Full Price ($3105)Non-residential options are also available*Deposit only (by 30 August 2017) Admin code D4Early Bird Full Price ($2195)Your deposit will be taken and our admin officer will contact you regarding the full price for a non-residential registrationTotal $ 0.00 Are You Eligible for $100 Discount*If you are applying for a Special Group Discount please list the Trainer or Organization name below. Previous participants are also entitled to the Group Discount.YESNOPlease continue completing the remaining fields.Group Discount Enrolments If you’re a previous participant, or belong to a Peer Support Group, or are a member of one of our recognised Trainers Groups you may be eligible to receive a discount of $100 of the registration cost. Please complete the fields in this section and our administrative team will check your eligibility for the $100 discount. To ensure your place is booked we recommend that you select your desired accommodation option and select to pay the deposit now. You will then be notified of the final amount payable from our admin team via email.Please Provide Details*In order for our admin team to determine your eligibility for the $100 discount please provide additional information to support your claim for the $100 discount (e.g) which Peer Support Group do you belong to? Or provide your Trainer's name in this field.)Thanks for providing your details, our admin team will check the details you've provided and will email you shortly with final payments costs.Personal DetailsName* Please selectMr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Contact DetailsEmail Mobile number*Previous Experience*Please provide a brief summary of your background and experience if any, with Family/Organizational Constellations. This is not necessary if you have attended any of the previous Intensives.Payment Method*Bank TransferChequePayPal Direct transfer I have transferred the amount, listed in the 'total' section to: Account name: Australasian Constellation Intensive St George Bank BSB 112 879 Account number 487 750 996 INTERNATIONAL SWIFT CODE: SGBLAU2S Enter the reference details you have entered as part of the Bank Transfer in the field below I understand confirmation of my attendance to the Australasian Constellation Intensive will not be finalised until funds have been processed.Reference Details* As you've selected the payment method of PayPal when you click the Submit button you will be taken to PayPal to finalize the payment As you've selected to pay using a cheque please make the cheque payable to: Australasian Constellation Intensive. Send the cheque to: 332 Lower Plateau Road Bilgola, NSW 2170 Let us know...*Please let us know how you heard about the intensive.Enquiries Enquiries about setting up a payment plan or accommodation queries please contact our Administration officer Tracey Inglis email@example.com. All other enquiries about the training please contact us via our Contact pageWorkshop Agreement As part of my registration I agree to the following conditions of attendance: I understand the workshop may involve intense emotional experiences, I take full responsibility for myself. and will ask for support if needed. I am emotionally and physically stable. If I suffer any significant physical or psychiatric condition, I agree it is my responsibility to ensure the organiser of the workshop is aware when I register. If I develop such a condition after registration I undertake to let the organisers know as soon as possible. I will also undertake to update the organizers on any significant change in the state of my condition as soon as possible. If I have any special requirements and needs, the workshop providers may not be able to meet and it is not appropriate for me to proceed then I understand they will notify me and I will be refunded my payment. I agree to indemnify Australasian Constellation Intensive from and against any loss, cost or expense resulting from my activities related to my participation at the Australasian Constellation Intensive. Participants also agree to being responsible for their own ethical practice. This requires of all of us that we limit how we use constellations to clients and situations for which we have the appropriate qualifications and experience. The workshop is not a training in the practice of psychotherapy, and the certificate presented at the end of the week is a certificate of attendance only.Cancellation Policy Due to our financial commitments to the Presenters and the Venue deposits and payments for the Intensive training are non refundable, however a substitute may attend in your place. Please notify us as soon as possible if you are transferring your registration.Agree to Workshop Agreement and Cancellation Policy* I agree By selecting this box you are agreeing to the 'Workshop Agreement' and 'Cancellation Policy' as stated above This iframe contains the logic required to handle AJAX powered Gravity Forms.