Course Booking/Registration Form

UK Mother Centre Course Registration Form

To enrol on a course at the Centre, please print out this form, and post it to the UK Mother Centre ~ please note: before enrolling on the Pure Meditation, Natural Spiritual Healing, Progressive Counselling or Teacher Training courses, please ask to speak to a course teacher.

Alternatively you can contact us at the Centre if you require any further information before booking, have any questions, or would like us to post a Course Registration form out to you. Thank you.

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

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

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

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

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

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

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.