PRINT OUT AND FAX THIS SECTION TO ENROLL..
AND FAX TO 021 856-2500
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Natural Health & Nutrition Course (NHN)
STUDENT REGISTRATION FORM
My name is_______________________________________________________________________________
My Street address is ________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
My phone numbers are: _____________________________________________________________________
________________________________________________________________________________________
My email address is: ________________________________________________________________________
Tick or circle the desired format below please...
I would like my course sent with A. 12 Audio tapes or B. 12 CD's
I would like to pay using the following method...
- CREDIT CARD _____ (If budget: 6, 12 or 18 months)
- BANK TRANSFER _______
- POST-DATED CHEQUES _____
A. CREDIT CARD
NAME OF CARD HOLDER:_______________________________________________________
CARD NUMBER: __________ ___________ __________ _________
EXPIRY DATE: __________________
LAST 3 DIGITS ON THE STRIP (VERY IMPORTANT!) ____________________
IF BUDGET, HOW MANY MONTHS? _______________
SIGNATURE OF CARD HOLDER:
_________________________________________________________
AMOUNT: R 3,990.00
B. BANK TRANSFER
Please arrange to transfer to:
Natural Way Wholesalers
Standard Bank
Helderberg 033012
Acc # 071174974
Then fax the “Proof of Payment” slip with this form. Thanks!
FAX # 021 856-2500
C. POST DATED CHEQUES – Enclose 3 cheques MADE OUT TO:
"The Natural Way Business & Nutritional Research Trust"
- R 1,400.00 (Today’s date)
- R 1,400.00 (Same date next month) and..
- R 1,400.00 (Same date the month after that)
and POST THEM to us at
PO Box 443
Gordon's Bay
7151
On receipt of the order and cheques we will dispatch a complete course to you at the above address.