Aloha身心灵排毒断食营报名表格

Aloha身心灵排毒断食营

Aloha Mind Body Soul Detox Retreat 31.10.2014~02.11.2014
参加者姓名 Participant's Name*

姓 First Name名 Last Name
出生日期 Birth Date:*

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性别 Gender*

男性 Male女性 Female
电邮 E-mail*
手提电话 Cell Number:*

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住家电话 Home Number:

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地址 Address:

Street Address

Street Address Line 2

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Emergency Information
紧急联络人姓名 Emergency Contact's Name*

姓氏 First NameLast Name
关系 Relationship*
电话 Phone Number:*

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Alt Phone Number:

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学员是否有任何过敏、慢性疾病或医疗条件呢? 如果是,请描述具体情况。 Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.
学员是否使用喷雾剂? 如果是,请说明指示。Is the participant prescribed an inhaler? If Yes, please explain any instructions.
您是如何知道我们的活动 How did you find out about this event*
Aloha身心灵排毒断食营配套 ALOHA MIND BODY SOUL DETOX RETREAT PACKAGE PRICE RM888

收费包括:断食配套（“保生堂”高纖維，“保生堂”巴西綠蜂膠 & LongRich生食）,精力汤,抗氧化热疗，养生保健課程，脊椎骨自我保護健康法, 火的净化, 2晚住宿。收费不含交通费。
付款 Payment

付款可通过银行汇款 Payment can be made by bank in to Maybank Account 1141 3310 2305 Payable to LIM YAN LING or CASH pay to Ling.
付款日期 Payment Date*

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备注 Remarks
同意书 Informed Consent and Acknowledgement

本人的身體健康良好，并能參與健身与瑜珈活动。本人確認已閱讀，理解並同意遵守所有主辦單位制定的所有條款和條件。本人同意将承担一切在”ALOHA身心灵排毒断食营活动”之前或之后期间发生的后果。如果發生事故、損傷或死亡，本人并不会要求主辦單位作出赔偿。I am in good health and feel confident in my ability to participate safely in this Fitness & Yoga Retreat. I confirmed that I have read, understood, and agreed to all terms and conditions set by the organizer. I hereby agree to abide them and will not claim any damage from the organizer in the event of an accident, injury or death which may arise before,during or as a results of my participation in ALOHA MIND BODY SOUL DETOX RETREAT 2014.07.18 ~ 20
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Aloha身心灵排毒断食营

Emergency Information

Aloha身心灵排毒断食营配套 ALOHA MIND BODY SOUL DETOX RETREAT PACKAGE PRICE RM888

付款 Payment

同意书 Informed Consent and Acknowledgement