Registration Form India

Registration Form India

To book and secure special discount, kindly fill in registration details and specify payment method and e-mail back within 48 hours.

Payment can be made via bank transfer, cash on the day with prior agreement, cheque with prior agreement or on-line booking with credit card. Registration details can be sent back on the attached form or via e-mail by filling the below details.

First Name____________________________________________

Last Name____________________________________________

Name to be written on Certificate (if different from above)

___________________________________________________

Date of birth__________________________________________

Preferred contact phone number____________________________

Permanent e-mail address_________________________________

Postal Address_________________________________________

City___________________State/County_____________________

Pincode/Zipcode _____________Country_____________________

Primary reason for attending course, for example personal development, self healing, become a Practitioner ___________________________

How did you find out about our training, for example newsletter, facebook, website______________________________________________

Special needs, for example special diet, wheel chair access ____________

Preferred payment method:

On-line bank transfer – YES/NO

Mera event booking link via credit card or cash on delivery, plus 2% – YES/NO

Cash on the day – YES/NO

Cheque payment, plus 2% – YES/NO

Payment will be made by (date)______________________________

Bank Transfer to Vitality LivingĀ 

Current account name: Vitality Living

Bank Name: Canara Bank, Puttaparti, Andhra Pradesh

Account number: 2351201000453

IFSC: CNRB 0002351

Go to Book me page to book your seat online.