Clear Intentions Course Booking Form

Booking Form

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massage and reflexology school in the west midlands

I wish to book onto the following Course/Workshop:

Course Title:

Course/Commencement Date:

1. Contact details:
Full Name:
Address:
Telephone/Mobile:
Email:
Present Occupation:
Qualifications:
Date of Birth:
Do you have any disabilities or conditions which may require any special help during the course/workshop:
How did you hear about the course/workshop:

2. Declaration:
I confirm that I have read and understood and am happy to accept the Booking Terms and Conditions (available by clicking here).
Signed:
Print name:
Date:

3. Method of payment:
Cheque PayPal Credit/Debit Card (all major cards accepted)

Please state amount due: £ (full amount)

If paying by Cheque:
Please print off this form and send it, together with you cheque to: Athena School of Natural Therapies Ltd, West Midlands House, Gipsy Lane, Willenhall WV13 2HA. Cheques should be made payable to Athena School of Natural Therapies Ltd.

If paying by PayPal:
Please print this form before clicking on the PayPal button below to make your payment (for PayPal payment instructions click here). Please note that a payment made via PayPal also forms acceptance of the Booking Terms and Conditions (available by clicking here ).

PayPal Transaction ID:

Once we receive your completed and signed Booking Form we will send you a confirmation/induction pack.