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Registration Form
www.Lifeworks4.me.uk
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Email
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Your email
Your Full Name
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Your answer
Your phone number (prefer mobile phone)
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Your answer
Your Postal Address
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Your answer
Are you registering for
*
A Class
A 1-1 Functional Integration session (in person)
A 1-1 Private ATM session
A Somatic Counselling session
Your Age
*
Your answer
Your Gender
*
Female
Male
Other:
Please outline briefly the particular issue/s you seek help with
*
Your answer
How did you hear about me
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Publication advert
Poster
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Other:
Please confirm your agreement to our Disclaimer & Bookings Terms
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