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BOOKING FORM: NERVE REFLEXOLOGY DIPLOMA
PLEASE PRINT YOUR DETAILS CLEARLY IN BLOCK CAPITALS
Full Name (required for certificate):
Address for correspondence:
Post Code:
Contact telephone number:
In order to receive your pre-course learning material, please supply your:
Email address:
Please confirm you are happy for your details to be added to our mailing list for future courses and workshops:
TICK ALL THAT APPLY:
Level 1 only (LONDON)
Level 1 only (BRISTOL)
Level 2 (BRISTOL)
Level 3 (BRISTOL)
FULL DIPLOMA
I wish to pay my deposit of £250 by:
Cheque:
(Payable to Dr Carol Samuel)
PayPal
Bank Transfer (Sort Code: 30-93-97 Account ref: 32454660.
Please use the reference: MNTNR2016.
I would like to register for the full diploma and enclose a deposit payment of £500. Furthermore I accept that payment
of £290 will become due 4 weeks prior to the commencement of the level 2 and level 3 start dates.
Signature:
Date:
PAYMENT OPTIONS: To secure your place on this course a deposit of £250 is payable in advance. If registering
for the full diploma a deposit of £500 is required.
Cheques should be made payable to Dr Carol Samuel and returned with this form to:
Reflexmaster, 46 Penk Ridge, Havant, Hants. PO9 3LU
Your place on the course will only be confirmed once the fee has been paid. Deposits are non-refundable. You may send
a substitute delegate provided they meet the workshop criteria described on the website www.reflexmaster.co.uk and
before the Level 1 course commences. In the unlikely event that a course needs to be cancelled Reflexmaster will provide
14 days- notice wherever possible and advise you of alternative date(s)/venues(s). Reflexmaster does not accept
responsibility for expenses incurred under these circumstance.