SupportNet 2016: Register Now

Name and Surname *

Cell Phone Number *

Email address

Place of employment *

Position *

Have you been trained as a BC mediator? *

Yes

No

Which SupportNet session/s will you attend? *

Meeting 1: 12 March

Meeting 2: 04 June

Meeting 3: 10 September

Total Payment Due *

R25 per mediator per meeting and R45 for others per meeting. Payment can be made at the SupportNet Meetings.

Select your T-Shirt size (for mediators only)

Comments/Questions

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