Self Realization Meditation Healing Centre Course Registration Form

UK Mother Centre Course Registration Form

Before enrolling on the Pure Meditation, Natural Spiritual Healing,
Progressive Counselling or Teacher Training courses,
please ask to speak to a course teacher.

Course...............................................................Dates.......................Fees £........................

Course...............................................................Dates.......................Fees £........................

Residential/Daily (please delete one)

For which I enclose the full fee(s) of £.......... (Please make cheques payable to the Self Realization Meditation Healing Centre. Thank you.)
OR
Debit my Mastercard/Visa/Visa Debit/Maestro/Solo/Electron (circle one)

No...................................................................
(Please send your credit card security number separately or ring us with details)

Expiry Date.......................

Solo/Maestro Issue No..........Solo/Maestro Start Date....................

Signature ..............................................

Name (as on card)....................................................................

Address.......................................................................................

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....................................................................................................

Tel. No. (home)............................................................(work).......................................................

Email Address:.............................................................................

Special needs .....................................................................................................................

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How did you hear of the Centre?

Leaflet/poster at........................................................................................................

Recommended by ....................................................................................................

Magazine/paper/article in ........................................................................................

Other........................................................................................................................

....... Please tick here if you DO NOT wish to be added to the SRMHC Mailing List - thank you.

Please print off this form and post it to us at the UK Mother Centre.
(Please do not e-mail the form to us. Thank you.)

Self Realization Meditation Healing Centre
Laurel Lane, Queen Camel, Yeovil, Somerset, BA22 7NU, UK.

Tel. 01935 850266
Fax. 01935 850234.

Course Programme

Registration Form for Accommodation Only (Not Courses)

Name .........................................................................................