Suaimhneas Reflexology

Application Formfor Suaimhneas Reflexology Course

Please print out this form and return to Suaimhneas Reflexology with a photo and deposit.

Name: Address: Phone numbers - Home: Mobile: Email address: Date of Birth: Occupation: Education to date: What is your reason for taking this course?

I understand that an Induction night will be held on 16^th of September at 7:30pm, just prior to the start of the course.

I enclose herewith payment of €450 as deposit for September 2009 class. Cheques should be made payable to Suaimhneas Reflexology and forwarded to Suaimhneas Reflexology, c/o Walmer College and Holistic Centre, River House, Raheny, Dublin 5.

Once accepted into the course deposit of €450 is non-refundable.

Payment options (please tick):

One payment of €1,750 on September 20^th 2009
OR
Three payments
- €800 payable on September 20^th 2009
- €600 payable on December 1^st / 2^nd 2009
- €410 payable on February 2^nd / 3^rd 2010

I certify that the above information is correct and I understand that deposits and fees are not refundable under any circumstances should I not take up my place or fail to complete the course. I also agree to pay any additional exam fees by the stated dates. I also attach a photograph to this application form.

Signature: Date:
Deposit included: Photo included: