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Last name *

First name *

Greeting *

Mrs
Mr
Dr. (female)
Dr. (male)

Email (please double check there are no typing mistakes ! *

Profession *

Address 1 *

Address 2

Address 3

Zip code *

City *

Country *

Land phone

Cell phone

V.A.T. - MwSt number

Seminar you wish to attend *

Copenhagen 2012 Balance Method class
Berlin 3 Essentials Level 3
Tel Aviv Balance Method class
Paris 2012 Balance Method class
Berlin 3 Essentials Level 4
London 2012 Balance Method class
Melbourne 2012 Balance Method class
Munich 2012 Balance Method class

Seminar days you wish to attend *

Payment option *

Credit card (secured Paypal)
Money Transfer (on a French account in Euro)
Check (from French account ONLY)

How did you know about the conference ? *

Please indicate the acupuncture association(s) you are member of *

Message (optional) *

Is this your first class with Dr. Tan ? *

Yes
No

Security Code: *

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