Nano Wellbeing
Sign up now to join a programme
”Whatever work needs to be done, whatever opportunity comes your way, whatever you have to share – this is the time, not tomorrow.“ - Sadhguru
Email address *
Participant's first name *
Participant's last name *
Programme registering for, (incl. Support package where applicable), start date *
Gender *
Please give date of birth (DD/MM/YYYY) for children - below 18 years old
I speak: *
Required
Phone number *
WhatsApp number
Your future self will thank you for investing in your wellbeing.
Confirm your attendance in the programme by making a transaction for the full investment amount.
You can make a bank transfer in Swiss francs (1) or in Euros (2) or use PayPal (3) The full amount should be received before the programme start date.

1) Swiss francs bank transfer:
Bank: BCGE
Account holder: Michelle Mayes
Bank: BCGE
IBAN: CH25 0078 8000 0502 8177 9
Address: 9 rue du 18 Aout, Gaillard, France

2) Euros bank transfer:
Bank: Societe Generale
Account holder: Mlle Michelle Mayes
Bank name: Societe Generale
Account holder’s address: 9 rue du 18 aout, 74240 Gaillard, France
IBAN: FR76 3000 3001 0100 0509 4174 012
BIC: SOGEFRPP

3) PayPal: paypal.me/MM108
Name of account holder. (We will use this to match the transfer with the participant.) *
Payment method *
Amount transferred, date transferred *
Discount code / Unwaged (where applicable)
Striving to serve you better
Please use this section to tell us honestly about your health, so we can recommend specific practices that may support you, or advise against other practices. The information will remain in confidence.

You may include: ladies who are pregnant (or trying to get pregnant) / open surgery in the last 6 months / keyhole surgery in the last 6 weeks / physical limitations / diabetes / heart conditions / communicable disease / spinal condition / chronic or severe pain / undergoing psychotherapy, psychiatric treatment or counselling / cancer / arthritis, osteoporosis / hernia / allergies / ligament injury / seizure, epilepsy / glaucoma / tinnitus.

Please mention if your doctor has advised you against doing certain movements or postures, or anything else you feel is relevant.
Health Note 1
Health Note 2
Health Note 3
Your Data
We store the data you enter in this form and will use it to:
* check that your previous experience and health background match the programmes you are interested in taking with us
* keep you up to date with programmes and offers.
We do not sell or disclose this information to third parties.You may request to view the information we hold about you.You may also request to be removed from our mailing list at any time.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy