VM treatmentVM treatment

Registration Form

 



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Registration Form

Personal/Professional Details

Title:

Surname: (please enter your name exactly as you wish it on your certificate)
Forename: (if you do not use your name as written here please add your short name or nickname in brackets)
Therapy/Qualifications*:

*It is assumed that you are a professionally established and qualified healthcare practitioner. Any doubts about this must be raised with us in case the signing of an appropriate Waiver is required.

Address/Contact Details
Postal address including postal code and county:
Country:
Telephone home:
Telephone work:
Mobile Telephone:
Contact phone for public**:
E-mail:

Website:

Course details
Name of course:
Start date of course: Day: Month: Year:
Course location:
Equipment you can bring: treatment table
Other

If this is your first Barral Institute UK course,  how did you hear about us?

**Please indicate whether you would like your name and public contact number to be published upon completing the course in directories of visceral manipulation and on this website find a practitioner page and  www.iahp.com.

Yes, please publish No, I do not wish to have my name listed.

I understand that all of the above information will be relied upon in confirming my place and in setting up my file.  I have read and agree to the privacy and cancellation policies.  I understand I will not receive confirmation of my registration until my deposit is paid.

I consent to receiving marketing information from Barral Institute UK via post, email or telephone.

Payment

Please note a deposit of £200 is required to secure your place on the class.  If you are international you are expected to cover all bank fees.

Cancellation Policy

Cancellations will be subject to a £50 fee if made 2 calendar months or more prior to the first day of the course. If you give less than 2 calendar months notice that you are unable to attend the class the full deposit of £200 will be forfeited. 

 

For classes taught by Jean-Pierre Barral or Alain Croibier personally the period for cancellation is extended  so that a £50 fee is chargeable if made 3 calendar months or more before the first day of the course. If you give less than 3 calendar months notice that you are unable to attend the class the full deposit of £200 will be forfeited. 

 

We will transfer prepayments less the cancellation fee to other courses/dates, otherwise they will be refunded, less the cancellation fee.

 

 

Select payment method: Cheque
Bank Transfer
Credit/Debit card (4% processing fee applies)

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Address: Barral Institute UK

26 Miller Road

Ayr KA7 2AY

Tel/fax: 01292 266335

Email: info@barralinstitute.co.uk