NIODA The Unconscious series

Through trauma towards creative innovations

with Dr Jerry Fromm and Richard Morgan-Jones on 26 & 27 April, 3 & 4, 10 & 11 May 2023
Your Name*

Prefix First Name Last Name
Your E-mail*

Confirmation Email
Address*

City

Country
Mobile Number*
Please ensure the information your provide is correct in case we need to contact you regarding your registration or to provide you with information regarding any late changes.
Name of your Organisation
What is your Work Role?
Participant's statement*

I agree to the program being delivered in the manner outlined in the NIODA webpage (including understanding my timezone).I have read the webpage and wish to be a participant.I agree to keep confidential all issues raised by the participants during the program.
I would like the invoice made out to:*

My organisationDirectly to me
I would like to register for the following:*

Six workshops $990
Subtotal AUD*
Please select your payment method*

I would like to pay by direct deposit directly into NIODA's account.I would like to pay by credit card and understand this incurs a surcharge.
Surcharge calculation
Total amount due AUD
To pay by direct deposit. Please complete and submit this form and proceed to your bank account and transfer the funds to the following account:

NIODA BSB: 313 140 ACC: 1201 6949

Please use your name as your reference.

Total to pay by Credit Card

AUDDescription

Do you have any requirements or special requests?
Would you like to be added to NIODA's mailing list?

Yes, please!
Thanks, but I'm already on it!No, thank you.
The workshop component is GST free.

A tax invoice will be issued to your email.

This secure payment site is hosted through Jotform and processed through eWay on behalf of NIODA
Should be Empty:

Through trauma towards creative innovations