Course Booking Form 2011-2012

Thank you for deciding to attend our course programme(s). Please print out this form, read and complete all parts of it and return with payment to:

Susanna Bellini
Bronze Dragon
51 Huntington Road
York YO31 8RL

Tel. (01904) 636216
Email: info@bronze-dragon.com

Title ______ Name ______________________________________________________

Address _______________________________________________________________

Postcode __________________

Tel. day: _____________ night: _____________ Email: ________________________

Course	Duration	Dates (circle your choice)	Investment	No of places	Total Cost
Reiki I (York)	1 day	1 Oct, 3 Dec 2011 14 Jan, 18 Feb, 14 Apr, 19 May, 16 Jun 2012	£85 (£75 concessions)
Reiki II Practitioner (York)	1 day + cases	2 Oct, 4 Dec 2011 15 Jan, 15 Apr, 17 Jun 2012	£145 (£130 concessions)
Crystal Healing and Colour Harmony	2 days	12-13 Nov 2011, 3-4 Mar 2012	£130
Crystal Healing Certificate	7 days	6-12 Oct 2011	£997
Shamanic Energy Weekend	2 days	5-6 May 2012	£195
Shamanic Energy Healing Certificate	7 days	3-9 Sept 2011	£997
Shamanic Dreaming Certificate	7 days	2011 TBA	£1397
Shamanix Practitioner	7 days	29 Oct - 4 Nov 2011	£997
Psychology of the Hidden Self	2 days	5-6 Nov 2011	£247
NLP - Mastering Success	1 day	19 Feb 2012	£85
NLP - Creativity	1 day	20 May 2012	£85

Reiki III Master (any location)	1 day (+ assist)	Call to arrange	£595

		TOTALS:
		GRAND TOTAL:

PAYMENT OPTIONS (Cheques/postal orders, made payable to Bronze Dragon)

Payment in full: I enclose a cheque/postal order for: £ ____________

Initial Deposit: I enclose £260 non-refundable deposit per course (or pay in full).

Remainder is due 1 Month before start date: £ ____________

Payment by credit card:

Card No. _______________________________________________

Expiry date: _______ Security No._________ (3 digit number on the back of the card)

Issue No. (Switch) ____

Please debit my card for £ _____________

Signature: _______________________________________

Do you require a location map YES / NO and / or accommodation details? YES / NO

Where did you first hear about Bronze Dragon ? Search engine / Advertisement / Friend / Other ?

Details ____________________________________________________

If you have any special requirements, please request these when booking.

Booking Conditions

Full terms and conditions are available here:
http://www.bronze-dragon.com/terms.shtml

I have read and agree to these terms and conditions:

Signed_______________________________________ Date _________________