Registration Page 5 day Sustainability Leadership Program : MOSS

Welcome Visitor!

Thank you for your interest in our 5 Day SUSTAINABILITY LEADERSHIP PROGRAM to be held on World Heritage Listed Fraser Island, September 9 to 13, 2019 staying at the award winning eco-friendly Kingfisher Bay Resort and Hotel.

Please complete the following registration form. You should receive an automatic confirmation of the booking once you submit your registration. We will then process the registration, confirm payment and provide a followup confirmation letter with a receipt. This should occur Monday to Friday within 24 hours of your booking. If no payment has been received - your registration will not be processed.


	Sustainability_Leadership_Program_Fraser_Island

I wish to register or provide an expression of interest for the 5 day Sustainability Leadership Program to be run Sept - 13, 2019 @ Kingfisher Bay Resort and Hotel, Fraser Island, Queensland. Price includes all meals (including a 5 course Australian Bush Foods degustation experience), single or twin share accommodation for 4 nights, ferry transfers to and from Harvey Bay, whale watching and swim, 5 day training program + take home resources. Prices excludes flights to and from Hervey Bay. There is a no refund policy (unless the program does not meet it's minimum quota), however substitute delegates are welcome. Accommodation options may change based on availability at resort at time of registration.

Name of Registrants. Please note you must list each person separately.

	*	I wish to register for ..... number of people
	*	Are you a MOSS Member
	*	Size and type of business
	*	First Name:
	*	Last Name:
	*	Company:
	*	Position:
	*	Email Address:
	*	Phone Number:
	*	Address:
	*	State:
		Second Delegate - First Name:
		Last Name:
		Company:
		Position:
		Email Address:
		Phone Number:
		Address:
		State:
		Third Delegate - First Name:
		Last Name:
		Company:
		Position:
		Email Address:
		Phone No:
		Address:
		State:
		Forth Delegate - First Name:
		Last Name:
		Company:
		Position:
		Email Address:
		Phone Number:
		Address:
		State:
		Direct Deposit Models of Success & Sustainability Pty Ltd, BSB: 033 009 A/C: 319 414 If paying by direct deposit, please use your company name as the reference. Once the money has been paid, confirmation and a receipt will be issued via email.
		Cheque: Please make cheques payable to Models of Success & Sustainability and post to MOSS, 306 Tindals Road, Warrandyte VIC 3113
		Credit Card: (please note a 2% credit card processing fee will be charged for all credit card payments. Note only Visa and Mastercard Accepted)

If Credit Card please add details below:

		Name on card:
		Card number:
		CVC No:
		Expiry Month:
		Expiry Year:

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