Asia Mind Dynamics - Registration Form

Asia Mind Dynamics Sdn Bhd Participant Registration Form

Thank you for registering for a training by Asia Mind Dynamics

It is our objective that participants really meet their own individual training objectives. This is why we keep the number of participants small, to allow for personalised experiences.

Please fill out the information below. We will then contact you shortly to advise you on our bank account details. We can only guarantee a seat once 50% of your payment has been received and confirmed by us!

* First Name

* Last Name

Title

* Organization

* Address 1

Address 2

* City

* State

* Postal Code

* Mobile Phone

Fax

* Email Address

Include my contact information into your mailing list

Yes

No

* Please register me for one (or more) of the following course

NLP Certified Practitioner Course/Timeline Therapy (TM) Techniques (January 10-13, January 18-20, January 25-27, 2008)

NLP Certified Practitioner Course/Timeline Therapy (TM) Techniques (March 6-9, March 14-16, March 21-23, 2008)

NLP Certified Practitioner Course/Timeline Therapy (TM) Techniques (April 25-27, May 1-4, May 9-11, 2008)

Certified NLP Master Practitioner Course (July 17-20, July 25-27, August 1-3, 2008)

“WORDS THAT CHANGE MINDS” Language and Behaviour Profile (LAB Profile) Practitioner Course (February 15-17, February 22-24)

“WORDS THAT CHANGE MINDS” Language and Behaviour Profile (LAB Profile) Practitioner Course (June 20-22, June 27-29)

Are you interested in any other form of training?

Did you attend similar trainings before?

Yes

No

If you attended, what did you most like?

If you attended, what did you least like?

* Indicates Response Required