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First Name
Last Name
Street, PO Box
Suburb
Postcode
State
Phone (H) include area code
Phone (W) include area code
Mobile
Email
Occupation
Event	Rick Hanson workshop
My Payment method is	Cheque Internet Banking
The amount I've paid is
My Internet banking Receipt Number is
Message to Registrar
In applying to register for the Openground course, I hereby absolve and indemnify Openground and all their servants, agents, employees from all liability arising from injury or damage in connection with my participation in programmes provided by or in connection with Openground.