Tel:  01494 880649     Mob:  07730 395700
E-mail: enquiries@beaconosteopathy.co.uk

  Body Response
  42 Aylesbury End, Beaconsfield, HP9 1LP.   Tel 01494 880649

  The Cedar Clinic, Marlow
   28 West Street, Marlow, SL7 2NB.   Tel  01628 477707

 

 

 

 

 

 

 
 
 
                          APPLICATION FORM                                

    1. Please complete a separate application form for each participant.  Then print off the form and post it to:
                      Flower Cottage,
                Moor common,
                Lane End,
                Bucks., HP14 3HX
       
    2. Please CLEARLY fill in your name and details.  Make the post code and any e-mail address very clear.
       
      3.
    3. Enclose any payment due, making the cheque payable to Beacon Osteopathy. 
      Please write your name and the course on the back of the cheque. 
      A receipt will be issued at the course, but if you need one sooner please request this.
       
    4. If you are applying to go on the waiting list please write ‘WAITING LIST’ in the payment section. 
      You do not need to enclose any payment.

A 20% deposit secures a place on a course.  Final payment is due 8 weeks before.

Course

Date

Location

Payment
 1.  

 

 

 
 2.  

 

 

 
 3.  

 

 

 

Total payment enclosed: 

 
   
  Name (Title, forename & surname)
  Address  
  Post code
  Telephone (work)  
  Telephone (home)  
  Telephone (mobile)  
  Fax
  Please tell us whether you would like
  your course details to be sent to you
  by post or by e-mail.		  
 If you would like to receive your course details via e-mail please fill in your e-mail address below. These will be sent as a .pdf file,
 and you will need Adobe Reader (available free from www.adobe.com) to open this.  Please be assured you will not receive
 spam e-mail from us.  Please read additional note below if you would like further course e-mails. Please give your postal address
 to stay on our postal mailing list.
  E-mail address
  Message:
  (Any other details you
  may wish to let us have)
  IMPORTANT NOTE:  If you would like to receive regular e-mails
  regarding up coming courses, please tick here and give your
  e-mail address above.  		   Tick:   
  Profession & Qualifications:
  Please indicate where you heard
  about the above course(s):
 


 

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