Irish Registration Form All Versions

Document Sample
Irish Registration Form All Versions Powered By Docstoc
					Thank you, for your interest in Plexus.

Below is the registration form for the Diploma on Bio-Energy Therapy. Please post the
completed form to:
       Plexus Bio Energy,
       Lismoyle House,
       Merchants Road,

It is sometimes difficult to outline the real value and effectiveness of the Plexus system by a
written course prospectus alone, so if you would like to find out more about this training
course, contact us by phone or email at the details below.

Many people in Ireland, Germany, UK, Portugal, and USA, including members of the
medical profession, have been trained in the Plexus health-care system and are having great
success with this therapy.

The success of the Plexus system has been well documented in both the national and
international press.

For assistance on completing the form, please contact Tina & Michael at the Galway office
by phone on 091-568855 or 087-2810055, or by email at .
                     Plexus Therapist Registration Form

Surname: _______________________         First Name: ___________________________

Address: __________________________________________________________________

Work Phone No: _________________         Home Phone No: ______________________

E-mail address: _________________        Date of Birth:   _____________________

Marital Status:    _________________     Occupation:      _____________________

Reasons for taking this course: _______________________________________________

Deposit:          ____________________
Installment 1:    ____________________        Installment 6: _______________
Installment 2:    ____________________        Installment 7: _______________
Installment 3:    ____________________        Installment 8: _______________
Installment 4:    ____________________
Installment 5:    ____________________

Signature: _________________________      _

Date:      ___________                    _

Shared By: