Upon submitting this form, please Fax/Email proof of payment to:

Telefax: 011 680 0981 or debbiehowes@mac.com

Banking Details:

Bank: Nedbank
Branch: Southgate
Branch Code: 153405
Acc No.: 1534010475
Acc Type: Cheque
Reference: LRRH Workshop

Name:
Surname:
Occupation:
Date of Birth:
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Registering for:	Module 1 - Day 1 Module 1 - Day 2 Module 2 - Days 1 & 2
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