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Enrollment form seminar Dr. F. Adajania & Dr. J. Dhingreja

Lesser used remedies & Miasms in historical perspective

Using the enrollment form below you can provide the information necessary to enroll for the seminar on 4, 5 and 6 May 2007. All fields need to be filled in. A copy of the information will be sent to the email address you have provided.

Name of participant (first & family):

 

  

Membership number and name of association:

 

  

Streetname & number:

 

  

Zip code & City:

 

  

Country:

 

  

Email (please verify this carefully!):

 

  

Telephone number:

 

  

Which days do you want to participate

Friday 4 May 2007 (Miasms)
Saturday 5 May 2007 (Lesser used remedies)
Sunday 6 May 2007 (Lesser used remedies)

 

  

Remarks:

   

By sending this form you agree that:

  • Fee is € 60,00 per day per person and will be paid before the start of the seminar.
  • Bankaccountnumber 4886717 (IBAN: NL85 PSTB 0004 8867 17 & BIC: PSTBNL21) of Rob Willemse, Mirabelweg 24, 5632 PC Eindhoven, Netherlands
  • Restitution after 2 April 2007 is not possible if you decide to withdraw.
  • If the seminar is canceled by the organisation or lecturers the fee will be refunded.
   
 

 

 

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