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National Health Leadership Programme
Leading Transformational Change and Performance Improvement

 

1 : Your Information
Title eg Mr Mrs Ms Dr
Surname
Preferred First Name
Position
Organisation
Postal Address
Address line 2
Address line 3
Telephone
Cellphone
Fax
Email

2 : Payment Information
Course amount is $6,075 (including GST)
Please Invoice Me (tick box)
Post Cheque (details below)
Bank Deposit (details below)
Credit Card
Credit Card Information (only if Credit Card is selected)
Card Type Visa Bankcard/MasterCard
Card Number
Name on Card
Exp Date

3 : Register
Click to register

 

 

 

Cheque or Bank Deposit Information
Cheque :
Please print this form and post cheque to		 P O Box 460
Rangiora
North Canterbury
New Zealand
Bank Deposit
Please deposit funds into		 National Bank of NZ
Account Number: 060 665 0075795 00