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Longevitology Workshop Registration Form
初級班(Beginner): 6/15-6/16/2019(Sat, 1:30pm-5:30pm, Registration starts 12:00 PM)
6/16/2019(Sun, 1:30pm-5:30pm), 6/17/2019(Mon, 7pm-10pm)

中級班(Intermediate) : 6/18-6/20/2019 (Tu-Thu, 7pm - 10pm)

費用(Tuition) : 不收取任何費用,所有開支(場租,講義等)由學員隨緣樂捐.
Tuition is free. Appreciate your donation for supporting Longevitology.

地點(Location) : 525 Los Coches Street, Milpitas, CA 95035

聯絡人(Contact) : Adj. Center (408)784-6696, Sophy (408)504-5396,
Christine (510)999-2241 (CSXLAregist.SFbay@gmail.com)

預先報名(pre-registration):
** 課程採先到先上課方式,請預先報名以便我們印製您的報名表。
Class is first-come-first-served. Register now so we can print your registration form.

*** Pre-registration deadline is June 1, 2019 but may close if too many registration.
*** Space is limited. Please consider your registration seriously or reserve the seat for those in need to take the class. Thank you!
*** Please do not register twice, we will delete the duplicate record without any notice.
*** One person per record. Do not put two or more names in one registration. It will be treated as void record.
*** The minimal age to register is 14.
*** No P.O.BOX allowed for address.

I would like to register for Beginner Class (6/15/2019~6/17/2019) *
我想報名初級班課程 (6/17/2019~6/17/2019)
Required
I would like to register for Intermediate Class (6/18/2019~6/20/2019) *
我想報名中級班課程 (6/18/2019~6/20/2019)
Required
Chinese Name (if any)
中文姓名
Your answer
English Name (first name, Last name) *
英文姓名
Your answer
Gender *
性 別
Occupation
職 業
Your answer
Age *
年 齡
Your answer
Address *
地 址
Your answer
City *
居住的城市
Your answer
State *
州名
Your answer
Zip *
郵遞區號
Your answer
Phone (H) *
家裡電話
Your answer
Phone (C)
行動電話
Your answer
Phone (O)
公司電話
Your answer
Religion
宗 教
Your answer
Class is teaching in Chinese. Do you need English Translation? *
需要英文翻譯?
Email Address *
電子郵件信箱
Your answer
How did you know about this organization?
您如何認識長生學?
Your answer
** Workshop is free; appreciate your donation for the workshop expense. *
本研習會不收任何費用,所有開支(場租,講義等)由學員隨緣樂捐
Required
** This signatory hereby agrees to assume full and complete responsibility for personal safety and personal property for the entire duration of the seminar, and hereby waives any rights to bring legal action against the Chang Sen Xue Longevity Association for any and all loss or injury incurred under any circumstances, including but not limited to, fire and theft. *
本人自身安全與財物自行負責,如有任何狀況,本人願意放棄法律追訴權
Required
You are required to sign the form when you check in on the first day of the class. *
您本人必須於第一天報到時親自簽名
Required
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