(In association with the Scenar Practitioners Society of Ireland)                                                                                      (www.scenartherapyireland.com)                                            

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BOOKING FORM

DATE:

NAME:                                                                                                              DATE OF BIRTH:                              .

ADDRESS:                                                                                                                                                 ___________ .

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TEL.NO. (home):                                      (work/Mobile):                                                                .

E-MAIL:                                                                                                                                                  .

I wish to book my place on the next    Foundation course, Module 1,2,3,4,5,6.7.8  (Please circle relevant one)

Or name of other advertised course:___________________________________________________________________

Have you studied any other form of healthcare? 

Deposit: Please post your non-refundable deposit of  €50.00 to John Garvey NOW to secure a place.

(Deposit is refundable only if course  does not take place)