Workshop Schedule in Chinese Mainland Cities 2015-2016

 

 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!