Booking Form

Living Well with Chronic Pain and Illness Course

September 10th 2008 – October 29th 2008 (8 Weeks)

Thursday Afternoon 2:30 - 5:00 PM

Venue – The Yoga Studio 

I would like to attend the above course and enclose a non-refundable deposit of £50.00.
The balance will be paid in full before the start of the course

 Course Fees (please tick as appropriate)

􀂉 £200.00 - Waged

􀂉 £150.00 - Low Waged

􀂉 £120.00 – Unwaged 

Name               ____________________

Address         ___________________

___________________

_______________

Post Code        ___________

Phone             ________________

Mobile              ________________

E-mail             ___________________________

Your contact details will be kept by us and used to inform you of future Breathworks events. We would also like to pass these details to Breathworks in Manchester so that you can be informed of news and events on a national basis.

Please indicate your consent to this here.   􀂉 I consent       􀂉 I do not consent

Signature        ___________________________

Please note cash can only be accepted if delivered by hand and all cheques are to be made payable and sent to:-

Breathworks Cardiff

12 St Peter's Street

Roath, Cardiff.

CF24 3BA

 

To be returned A.S.A.P.