APPLICATION FORM FOR SLOVENIA – 2018

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 June – Individual therapy (ITAU Centre)
Saturday, 16th June – The healing circle of light (ITAU Centre)
Sunday, 17th June – Event in Sveta jama, Socerb (near Koper)
Monday, 18th June – Individual therapy (ITAU Centre)

HAVE YOU EVER HAD THERAPY?
YES
NO

SPACE FOR YOUR REMARKS OR COMMENTS (OPTIONAL):

CAPTCHA