Holistic De-Stressing

REGISTRATION FORM
PERSONAL PARTICULARS (Please fill up your particulars in BLOCK LETTERS.)
Prof Dr Mr. Mrs. Mdm. Ms. Full Name: _____________________________________________________
Name to be printed on certificate : ___________________________________________________________________
Job Designation: ______________________________

Organisation: ______________________________________

Mailing Address: _________________________________________________________________________________

___________________________________________________________________ Postal Code: ________________
Mobile No.:____________ Office No.:

_______ Fax No.:_______________ Home No:__________________

Email Address: _________________________________________________________________________________

Payment by Cheque/ Einvoicing.

Day 28 May 2012

Time 9.00 a.m. to 5.00 p.m.
Workshop Fees - $175 including material, certificate and tea breaks
$160 each for a group of three participants.
Venue 3 Temasek Boulevard #02-161/163
Suntec City Mall
e-life@suntec
Singapore 038983
Registration Starts at 8.15 a.m.
REGISTRATION & PAYMENT
You may post, fax or email the completed registration form to the Ms Reena Goenka.
Tel/Fax: (65) 64558875

Mobile: (65) 92385141

Email: info@insightfulreflections.com

Mailing Address: 45 Lentor Place, Singapore 489032.

Payment by crossed cheque should be made to Insightful Reflections. Please write your name, address and contact number on the reverse side of the
cheque. Registration will only be confirmed after full payment is received.