Registration / Subscription Form -Acupressure Club

Name                                   :


Age & Date of Birth              :


Postal Address                     :


Telephone                                    :


email address                      :



*I would like to join the Acupressure Club as a Member and avail the free acupuncture treatment consultation for one year Registration Fee of Rs. 1000/- (Rupees one thousand only)is enclosed by Cash / Cheque / Draft drawn in favour of Mrs. Meera Bhojraj.


*I would like to subscribe only for the Acupressure Newsletter (and do not want to avail any free treatment) subscription fee of Rs. 250/- (Rupess two hunderd fifty only) is enclosed by Cash/ Cheque/Draft drawn in favour of Mrs. Meera Bhojraj.


Date:                                                                                                                                                 Signature


Local cheques or Demand Drafts payable at Bangalore should be sent to Mr. Palyam Suresh 598, 11th Main, 5th Block, Jayanagar Bangalore - 560 041.

* Strike out whichever not applicable.


Send this form to our Programme Coordinator

Mr. Palyam Suresh 598/1 (upstairs), 11th Main, 5th Block

Jayanagar, Bangalore - 560 041