You are booking into

Creative State's Autumn Drama Workshop
Monday 15 April to Friday 19 April 2013
10am-5pm daily
Balmain Town Hall, 370 Darling St Balmain NSW 2041
$400.00 incl GST. Drama Workshop Terms and Conditions.

You opted to pay now with PayPal or Credit Card.
Firstly, a parent or guardian must complete the following form to register for the workshop. You will then be directed to make your payment.

STUDENT DETAILS

name

First Name

Last Name

gender

female

male

age

Student is 12 to 15 years of age at the workshop commencement.

date of birth

address

mobile

home phone

PARENT-GUARDIAN DETAILS

name

First Name

Last Name

relationship to student

address - if different to student

address

mobile

home phone

payment type

This is the method of payment you will use once you are directed to make payment after completing this form.

paypal account

credit card

acceptance of Drama Workshop Terms and Conditions

I accept