Registration- Guided self-help for bulimia nervosa

Name *

First Name

Last Name

Professional registration *

Registered Psychologist

Registered Psychiatrist

Registered Psychotherapist

Registered Counsellor

Registered GP

Registered Mental Health Nurse

Registered OT

Registered Social Worker

Other (please provide details below)

I will be paying by *

An invoice will be emailed to you following submission of this form. Payment is due in full 6 weeks prior to training date please to secure your space. In the case of cancellation due to COVID lockdown, the training will be rescheduled and your registration transferred to the new date. In this instance, a full refund will be an option. Full refund if cancelled >4 weeks prior to training, 50% refund if cancelled <4 weeks prior to training.

Bank transfer

Credit card (2.5% fee surcharge)

I would prefer to do this training *

(depending on demand, we may split this training into an in person day, and an online training day)

In person (Parnell, Auckland)

Via zoom

No preference