InterX Training Enrolment Form

Instructions

To reserve a place on the InterX training with Dr.Zulia Frost please complete the enrolment form below.

Enrolment form no. :
Name *
Surname *
Profession *

Training course *	Beginners course Advanced course

Address (optional)
City / town
County
Postal code/Zip
Country *

*


*


Questions / Comments (optional)

* mandatory fields
Important : We keep your information confidential

Training Fee
Training fee is £125 +VAT. Please contact Dr Z Frost to reserve a place by sending this enrolment form together with the 10% deposit to the address below, please make it payable to ‘IX Pain Clinic ltd’ :

Address:

"InterX Clinic ltd"
Maple House
Bayshill Road
Cheltenham
GL50 3AW
UK

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