Watsu 3 in Poland

1. Personal data

This data is gathered and kept by Watsu Polska in order to conduct the registration for Watsu 3 course in Wadowice, Polad on 27 Sept - 1 October 2015 and effective communication with the participants. According to the law it is kept secured and each person can change data or remove the his/her agreement for keeping it by Watsu Polska at any time.

* 1. Name and surname

* 2. Street address

* 3. Address

City, ZIP code, country

4. Phone with country extension: +

For emergency sms contact

* 5. E-mail

6. I am

All eating

Vegetarian

Vegan

Other

7. Please help me with:

If you choose Other please specify in the field of Message to Organizer at the end of this Form.

Transfer from the airport

Transfer to the airport

Arrange additional stay

Arrange accommodation for additional person

Arrange a visa

No, thank you, I will arrange all by myself

Other

* 8. I have

Compleated Watsu 2 and passed a Supervision of Watsu 2

Completed Watsu 2 and want to arrange my Supervision before the class

Other

* 9. I want to participate as

Full time Student (800 Euros for class + hotel and meals during whole course)

Auditor (620 Euros for class + hotel and meals during whole course)

Other (specify in the Message to Organizer)

* 10. I want my invoice for

A person

A company

11. If company, please provide data

Company name, adress, tax number

* 12. I am going to take part in Watsu Conference 2-4 October in Krakow

Yes

13. Message for the Organizer

* 14. Name ans surname (Signature)

I state I know and accept terms and conditions of participation in Watsu 3 course on 27th September - 1st October 2015 in Wadowice, Poland available at www.watsu.org.pl

* 15. Date

Ankieta

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