Japan Moxa Study Tour 2020
September 7th - 14th - REGISTRATION FORM
Email address *
Full Name: *
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Address: (including Suburb &Postcode) *
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Phone (including Area Code) *
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Email *
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Passport Number (optional – may be used in the case of an emergency)
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NEXT OF KIN - Full Name: *
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NEXT OF KIN - Address: (including Suburb &Postcode) *
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NEXT OF KIN - Phone (including Area Code) *
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NEXT OF KIN - Email *
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Any Health Issues I should be aware of: *
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Dietary Requirements (for group meals, etc): *
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Do you wish to be paired up with someone for twin share accommodation (this cannot be guaranteed): *
I have arranged to share with - Full Name:
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Payment via Direct Deposit *
Tell me briefly, why you wish to partake in this tour:
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Please give a brief description of your experience with moxa:
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