00386 4 578 04 08 info@itau.si

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APPLICATION FORM FOR SLOVENIA – 2017

Please, select the therapy:

YOUR NAME ( required field)

EXACT ADDRESS ( required field)

CODE NUMBER, CITY ( required field)

PHONE ( required field)

E-MAIL ( required field)

PLEASE, SELECT AND ENTER THE DATE OF THERAPY:
Friday, 15th December – Individual therapy (ITAU Centre)
Saturday, 16th December – The circle of light (ITAU Centre)
Sunday, 17th December – Christmas Darshan (Golf Hotel)
Monday, 18th December – Individual therapy (ITAU Centre)

HAVE YOU EVER HAD THERAPY?
YES
NO

SPACE FOR YOUR REMARKS OR COMMENTS (OPTIONAL):

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IMPORTANT!!!

I hereby agree to accept the treatment freely and at my own risk. I am aware of the fact that Stephen Turoff is not a doctor and that his therapy is complementary, not alternative.
We strongly urge you to continue with any medical treatment and medication programme until advised to stop by your doctor.

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