Registration form for Niromathe seminars

Session

Choose first a desired session

Last name :

First name :

Adress :

Town :

Province/State :

Country :

Postal code/Zip code :

Phone :

Cell Phone :

Mail :

You will receive your enrolment confirmation through email

Diplomas :

PHYSICIAN

MIDWIFE

NURSE

PSYCOTHERAPIST

OSTEOPATH

NATUROPATH

MASSOTHERAPIST

HOMEOPATH

BOWEN THERAPIST

OTHER MANUAL THERAPIST

Method of payment : One-time paymentPayment in two instalments

Registration : One student