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VRT MEMBERSHIP NETWORK
APPLICATION FORM

Please print this form to apply to join the VRT Membership Network

The joining fee is now only £20 per year, £25 for those living overseas.

Please post  to:
Booth VRT Ltd (Registration), Suite 205, 60 Westbury Hill, Bristol, BS9 3UJ, UK
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I wish to register for VRT Membership Network : please tick
¨ I enclose a cheque for £ ______    payable to Booth VRT Ltd. drawn on a UK bank

¨
Please charge my CREDIT CARD : Visa / Mastercard /Switch (circle) with £ _______

Card No: ___________________________________________________________

Expiry Date ____/____ and for Switch card only:  Issue: _____ valid from ___/___
(If paying by credit card you may fax this completed form to 0117 9626746)

Name_________________________________________________________________

Address_______________________________________________________________

____________________________________________Post/Zip Code: _____________

Tel No: _____________ Fax No: _________________Email______________________

Signed: _____________________________________________________

Reflexology School Attended ____________________________________
Qualification_________________________________ Date ______________________

VRT Courses Attended (Please give place and date if possible)
Basic   _______________________________________ _________________
Advanced ______________________________________________________
Other ________________________________________________________

VRT office use only: Date received :____________ Details sent:____________