Expression of Interest - Practitioners' Learning Circle
This registration form is for the Practitioners' Learning Circle. All information being collected here will remain confidential and kept safely with Mioi Forster-Nakayama.
Date of Registration *
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Name (First and Last Name) *
Gender *
Email Address *
Occupation *
Would you like to present your clinical case? *
Would you like to subscribe to the newsletter of Intertwine Body and Mind, so that you will be informed of workshops and other relevant sessions in future? *
Please confirm your payment (It is $10. This payment is for the admin purpose only. ) Please pay Mioi Forster-Nakayama (facilitator). Australian National Bank BSB: 085-232 Acc: 84-406-8849 For non-Australian participants, please pay through PayPal by typing the email; info@intertwinebodymind.com Thank you! *
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