Workshop Schedule in Cities of Chinese Mainland 2015 

    

Tel : (010) 64130582, 4000-650-970, 13661058751,   

Email: [email protected]  

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: 

Current Employer:

Professional Title: 

Home Tel.:

Office Tel.: 

HP:

E-mail:  

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 that 

1) The above information is true and accurate;

2) I shall bear all the consequences resulting from false information. 

Applicant’s Signature:_________________________________________________ 

(*Registration deemed unsuccessful without the signature above.) 

Date: ____________________________ (month/date/year)

May you always enjoy good health and happiness!