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Stay Healthy Workshops in Chinese Mainland Cities in 2016

Time:2016.03.25 02:03 2321


 

     

        
Tel : (010) 64130582, 4000-650-970, 13661058751,   
 
Email: paidalajin123@gmail.com  
 
If you’d like to attend a workshop, please fill in the registration form below and send it to the above email
 
Paida and Lajin Workshop Registration Form
 
* Please fill in the form below. Do not leave the spaces blank. Fill in N#A if you cannot provide relevant information.
 
Workshop Duration:
 
From _____________________________ (month/date/year)
 
To _____________________________ (month/date/year)
 
Given Name:
 
Family Name:
 
Gender:
 
Age:
 
Valid ID NO.:
 
Valid passport No. & Nationality or Other Documents: 
 
Current Employer:
 
Professional Title: 
 
Home Tel.:
 
Office Tel.: 
 
HP:
 
E-mail:  
 
Address & Postal Code:
 
 
Source of Information about the Workshop:
 
(√) Internet ( ) Books ( ) Messages ( ) Friends ( ) Others: ____________________
 
 
What health problems do you have? (√)
 
Neck problem ( ) Lower back and leg pain ( ) Constipation ( ) Frozen shoulder ( ) Insomnia ( ) Obesity ( ) Heart problem(s) ( ) High blood pressure ( ) Diabetes ( ) Gynecological / prostate disorders ( ) Others: __________________________
 
I hereby state that 
1) The above information is true and accurate;
2) I shall bear all the consequences resulting from false information. 
 
Applicant’s Signature:_________________________________________________ 
(*Registration deemed unsuccessful without the signature above.) 
 
Date: ____________________________ (month/date/year)
 
 
May you always enjoy good health and happiness!    
 
 


 

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