REGISTRATION FORM

for

THE BALI PROJECT

 

You can pay online via the Harbord Homeopathic Clinic Online Shop and then fill in your details on the registration form and send it in.

OR you can register by saving the form below as a Word document and emailing it to: 

info(at)aurumproject.org.au   

OR

Print out and complete the REGISTRATION FORM BALI PROJECT 2013 and post to:

The Aurum Project, 110/20 Dale St, Brookvale, Australia 2100 NSW.  

PART ONE  (of 4 parts) – Payment

Name…………………………………………………………………………………………………………….

Address……………………………………………………………………………………………………

Suburb………………………………………..State………………………………………

Country……………………………………….Post Code………………………..………….

Phone: Work (      ) ….…………………..………….Home (       ) ………………………………

Mobile (Australia)……………………………………………………………………………

(Bali)………………………………………………………………………………………….

Email…………………………………………………………………………………………………..

Seminar fee includes:

• Days 1, 3 & 5 seminar attendance. Morning and afternoon tea.
• Days 2 & 4 field trips. Bottled drinking water.
• One copy of the Bali Project Manual, (posted to you after the seminar)

Seminar fee does not include:

• Accommodation. A wide range of accommodation from budget to luxury is available.  See recommendations on this website.
• Airfare. (Book early; seminar is during school holidays.)
• Airport/hotel transfers (some hotels include this service)
• Meals. Breakfast is included with some accommodation. Lunch & dinner venues are bountiful, close by & affordable.
• Day 6 Post Seminar Coral Reef Trip (this is optional, additional  cost $150) includes: bus transport from Ubud to hotel, overnight accommodation, snorkeling equipment hire, guide fees, return bus transport to Ubud.

Payment

• Seminar Fee:               $700
• Super Early bird:          $500 (pay by June 30th 2012)
• Early Bird Discount:      $600 (pay by March 3rd 2013)
• Optional marine field trip:  $150

……………………………….TOTAL $……………

Payment methods in order of preference:

Online: Harbord Homeopathic Clinic Online Shop

Direct deposit: Aurum Project BSB 032191 Account Number 252433

Include your name & ‘Bali Project’ on bank record

Cheque Please make cheques payable to: The Aurum Project

Credit Card You can choose to complete your credit card details below or phone them through to: 61 2 99059415

Cardholder Name _______________________________________________

Card Number: _______/________/_______/_______

Expiry Date:  ­­­­­­­­­­­­­­_____/_____

Signature_____________________________________

REFUND POLICY: NOTICE FOR REFUND (LESS $100 ADMINISTRATION FEE) IS REQUIRED BY 19th April 2013

NO REFUND IS AVAILABLE FOR CANCELLATION AFTER  19th April 2013

PART TWO (of 4 parts) – At The Seminar

This section is designed to gather information from participants to best meet your needs at the seminar. Your input here will help to develop ‘The Melting Pot’ sessions, to offer practitioners an opportunity to air and hear of clinical experiences. These will be relaxed, interactive discussion groups. For example, pterygium, dupuytren’s contracture and tinnitus are extremely common problems, found throughout homeopathic texts, but who among us can confidently treat them?

What conditions or illnesses would you would like to find out about at the seminar?

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Comments:

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Anything else that you would like to share in the Melting Pot sessions? These will be relaxed, interactive discussion groups.

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PART THREE (of 4 parts) – For The Bali Project Publication

This section is OPTIONAL but in the spirit of the Bali Project, we sincerely hope that you will become a part of ‘The Bali Project Manual.’ This publication is intended to contain a range of successful treatments and to become a great clinical manual for homeopaths. Your input is valued and encouraged. Attendees, and others after the seminar, want to hear more about your clinical specialties.

Name ………………………………………………………………………………………………………………………

Address……………………………………………………………………………………………………………………………

Suburb………………………………………..Country ………………………………………………………………

Website(s) ………………………………………………………………………………………………………………………

Practising since …………. In /at……………………………………………………………………………

Qualifications (include non-homeopathic qualifications)

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Area(s) of expertise / clinical strengths:

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Other areas /modalities of interest:

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Published paper(s):

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Publications:

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Eureka! moments in practice?

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Greatest difficulties:

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Greatest discoveries

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Wonder remedy(s) – describe your use of this

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Wisdoms /opinions

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PART FOUR (of 4 parts) – Helping Out Before and During The Seminar

There is no obligation, but if you have any of the skills listed below, and would be happy to contribute in any way, great or small, please indicate below.

❑ Journalistic experience (gathering material for publication during the seminar)

❑ Fast typing speed / shorthand experience

❑ Editing experience (preparing the publication)

❑ Speaking Indonesian (assisting Tjok organising venues and various other local arrangements)

❑ Geological expertise / experience

❑ Botanical expertise / experience

❑ Marine biology expertise / experience

❑ ‘On the ground’ issues at the venue (admin, general practical tasks)

❑ Administration help prior to the seminar (assisting the Aurum Project with seminar preparation)

❑  Anything else?

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Thank you, see you in Bali!