Registration Form UK

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

Payment can be made via bank transfer, credit card, cheque or cash.

First Name____________________________________________

Last Name____________________________________________

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

___________________________________________________

Date of birth__________________________________________

Profession___________________________________________

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

Cheque payment – YES/NO

Cash on the day – YES/NO

Credit card, plus 3% YES/NO

Paypal, plus 3% YES/NO

Payment to be made by (date) ________________________________

For ease payment details have been included below:

Bank Transfer to Rangana Choudhuri, HSBC

Account name: Rangana Choudhuri

International bank account number: GB34MIDL40461031461656

Branch Identifier code: MIDLGB2162L

Sort code: 40-46-10

Account number: 31461656

Bank Address: 122 Wembley Park Drive, Wembley Park, Middlesex HA9 8HT, UK

Cheques can be written in the name of Rangana Choudhuri and posted to

Rangana Choudhuri, 29 Century house, Forty Avenue, Wembley Park, Middlesex HA98RS, UK

Credit card payment – Go to Book me.

Paypal payment to vitality@vitality-living.com. Include additional 3% to cover paypal charges.