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VRT MEMBERSHIP NETWORK 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 -------------------------------------------------------------------------------------------------------------------------------- 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
____________________________________ Basic _______________________________________ _________________ Advanced ______________________________________________________ Other ________________________________________________________ VRT office use only: Date received :____________ Details sent:____________ |