Athena School of Natural Therapies

APPLICATION FORM

I wish to book onto the following Course/Workshop:

Massage & Pregnancy, 17-20th June 2008

1. Please provide the following information:


Name:
Address:
Telephone/Mobile:
Fax/Email:
Date of Birth:
Present Occupation:
Qualifications:
Previous experience in health related fields (if any):
Any other relevant information:
Please state if you have any disabilities or conditions which may require any special help during the course/workshop:
Please state how you heard about the course:


Fee:	Deposit: £100.00	Full fee: £375.00
2. Payment by CHEQUE ONLY: I enclose a cheque for £ made payable to Suzanne Yates .
3. Please sign and date: 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:
4. Please print the form and post to: Debra Goldston, Athena School of Natural Therapies, Hildon Villa, Pooley Lane, Moreton, Nr Newport, Shropshire TF10 9DU

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