Please print and fill in the following and send to:

Office and Administration:
Suite 427, 13 Austin Friars, London EC2N 2JX

Please note there are only a limited number of places for each course.

Full name: ………………………………………………………………. DOB : …………….

Address:……………………………………………………………………………………….

………………………………………………………………………………………………..

…………………………………………………………………………..Postcode…………..

Telephone: (day) …………………………………… (evening)…………………..

Occupation:…………………………………….……e-mail……………………………..

What briefly do you hope to gain from our course:

I wish to enrol on the course commencing:

1st choice………….……2nd choice…….…………

I enclose total fee (£995)/ deposit of (£160) £ …………………………….

Signature ………………………………………………………… Date …………………….

(I am over 18 years of age and agree to be bound by the school’s terms and conditions and contents of the prospectus and accompanying documents)

A deposit of £160 is required to secure your place on the course and sent along with your registration form to:

London School of Reflexology,
Office and Administration,
Suite 427,
13 Austin Friars,
London, EC2 2JX