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Booking Form
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Please complete the online form below, or download it here as a PDF to print and fax
Note:  All information in this application form will be treated confidentially.
Bookings are confirmed as soon as proof of deposit or payment is received together with this booking form.
Today's Date *
Name of Workshop (s) *
Workshop Dates *
Workshop Fee *
Title *
Surname *
First Name *
Date of Birth *
Medical Aid Name
Medical Aid Number
Physical Address
Postal Address
Home Telephone
Work Telephone
Mobile Number *
Email Address *
How did you hear about this course?

Educational Background/ Profession/
Work Experience


Have you ever attended any form of
Art Therapy before?


If YES, with whom and for how long?
Why would you like to participate in this
course/ workshop?

Any additional information you would
like to include?
Please note a deposit of R2000 or full payment secures your booking.
Please see banking details below.
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Bookings are only secured by means of a completed application form plus deposit or payment.
Please find bank details below:
Account Name:
Bank:
 
 
 
 
 
 
Please send completed application
form & proof of payment to:
 
Reference:
 
Branch:
Account Number:
 
Art-Cafe
Email : sami@arttherapy.co.za
FAX : 086 604 6678
SMS : 083 326 6655
Your Name & Course
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622 385 909 48
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