Training Enrolment Form

Enrolment form

	To reserve a place on the InterX training with Dr.Zulia Frost please complete the enrolment form below.
	Personal Details
First name (*)	Please type your first name.
Last name (*)	Please type-in your last name
	Training information
Event (*)	Please choose the event which you want to attendPlease choose the event which you want to attend
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	Contact information
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	(*) mandatory fields Important : We keep your information confidential
	Training Fee Training fee is £150 + VAT. For online payments a 6.20£ handling fee will apply.
	Payment methods By cheque : To ensure your place on the training course please submit this 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 By Credit Card using Paypal : After submitting this form you will be automatically redirected to make your payment in full using your Credit card via PayPal. Simply continue and complete the payment. Thank you.