APPLICATION FORM FOR SLOVENIA – 2019

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, 29th March – Individual therapy (ITAU Centre)
Saturday, 30th March – The healing circle of light (ITAU Centre)
Sunday, 31st March – Individual therapy (ITAU Centre)
Monday, 1st April – Individual therapy (ITAU Centre)

HAVE YOU EVER HAD THERAPY?
YES
NO

SPACE FOR YOUR REMARKS OR COMMENTS (OPTIONAL):

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