27 – 28April 2013, Lok Hup Ba Fa Workshop Registration Form
NATIONAL CENTRE, BAYSWATER
52 Railway Parade, Bayswater WA Ph 08 9371 7033
Please register by24 April 2013
Please send registration to: PO Box 10, Maddington WA 6989 Fax: +61 (0)8 9493 2428 Email:
Name Mr. Ms......
AddressNumber and Street ......
City ...... State ...... Postcode ...... Country ......
TelephoneHome ...... Mobile ......
E-mail & DOBE-mail...... print clearly Date of Birth ......
MembershipBranch...... Region ...... Country (if o’seas) ...... Instructor
EmergencyContact...... Name ...... Telephone ......
TravelArrival date...... Flight...... Time ......
Departure date ...... Flight ...... Time ......
Airport transport required? At arrival: Yes No At departure: Yes No
Health ConcernsDo you have any health problems or special requirements?......
Please note that if you have any foodsensitivities or allergies you are advisedto make your own.. food arrangements. Vegetarian options will be provided but other food requests cannot necessarily be catered for.
WorkshopSat 27thApril 2013 1pm – 5:30pm
Sun 28th April 2013 9am – 4:30pm ...... . $220
No daily rates ......
LunchSun 28th April $10
Tick if Vegetarian :
Accommodation Billet Motel Nat Ctr (bed $20/night) Nat Ctr (floor $10/night)
National Centre accommodation: Friday night , Saturday night , Sunday night
Beds are limited. If beds not available, mattress on floor may be provided. Please advise under “Health Concerns” if you have a special health requirement for a bed.
Camping or caravanning notallowed in car park. A caravan park is located nearby
Billet requests require a minimum of 4 weeks’ notice. Suggested motel options will be sent if requested.
PAYMENT : Workshop fee: $ …….….. Meals: $ ….…..… Accom: $...... Total due: $...…......
FULL PAYMENT IS ENCLOSED: Make cheques to: Taoist Tai Chi Society of AustraliaDIRECT DEPOSIT (PRINTED RECEIPT IS ATTACHED): I have paid the total due by Direct Deposit to: BSB 066 107 Bank Acct No: 009 40083 using Reference Number: LHBAYAPR (pls also include your name in the Ref Number field). Date of payment: ……/……../…… and I attach my printed receipt.
I WILL PAY IN FULL ON ARRIVAL: Payment must be made at the Bayswater National Centre. Please do not pay at local branch. Credit card and EFTPOS available on site for in-person payment.
Please read and sign: I accept that the Taoist Tai Chi Society of Australia Inc and the local branch hosting the workshop are not responsible for any loss or damage to my personal property, or for any personal injury sustained. I undertake not to teach Taoist Tai Chi™ internal arts without the express consent of the National Instruction Coordination Committee of the Taoist Tai Chi Society of Australia Inc. I agree to abide by the by-laws and constitution of the Taoist Tai Chi Society of Australia Inc.
Signature...... Date ......
Office use only...... Amt received $………..Date……….TX no………..Branch………….Amt outstanding $......
Amt received $………..Date……….TX no………..Branch………….Amt outstanding $......
Page 1 of 218 January, 1996