Workshop Schedule in Chinese Mainland Cities 2015-2016
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 Tel : (010) 64130582, 4000-650-970, 13661058751,  Â
 Email: paidalajin123@gmail.com Â
 If you’d like to attend a workshop, please fill in the registration form below and send it to the above email
 Paida and Lajin Workshop Registration Form
 * Please fill in the form below. Do not leave the spaces blank. Fill in N#A if you cannot provide relevant information.
 Workshop Duration:
 From _____________________________ (month/date/year)
 To _____________________________ (month/date/year)
 Given Name:
 Family Name:
 Gender:
 Age:
 Valid ID NO.:
 Valid passport No. & Nationality or Other Documents:Â
 Current Employer:
 Professional Title:Â
 Home Tel.:
 Office Tel.:Â
 HP:
 E-mail: Â
 Address & Postal Code:
 Source of Information about the Workshop:
 (√) Internet ( ) Books ( ) Messages ( ) Friends ( ) Others: ____________________
 What health problems do you have? (√)
 Neck problem ( ) Lower back and leg pain ( ) Constipation ( ) Frozen shoulder ( ) Insomnia ( ) Obesity ( ) Heart problem(s) ( ) High blood pressure ( ) Diabetes ( ) Gynecological / prostate disorders ( ) Others: __________________________
 I hereby state thatÂ
1) The above information is true and accurate;
2) I shall bear all the consequences resulting from false information.Â
 Applicant’s Signature:_________________________________________________Â
(*Registration deemed unsuccessful without the signature above.)Â
 Date: ____________________________ (month/date/year)
 May you always enjoy good health and happiness!  Â