Workshop Application Form

Sat & Sun 24th and 25th May 2008 (2 additional half days to be mutually agreed).

Name______________________________________________________________

Address____________________________________________________________  

___________________________________________________________________

e.mail______________________________________________________________

Tel___________________Mobile______________________Work______________

Qualifications in Physical Therapy/Massage:

____________________________________________________________________

Deposit enclosed_____________________________________________________
(payment by cheque or p.o. payable Katie Losty)

                  Print out, complete and Return to:
Katie Losty,  Sandycove Health Clinic, 57a Glasthule Rd., Sandycove, Co. Dublin.
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