ENROLLMENT FORM FOR DOCTORS OUT OF INDIA
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Dear One,
We treat 'THE QUANTUM LEAP Training Program’ as a profound reverence towards our Master Dr. Hahnemann and responsibility towards Homoeopathy in general and we expect of you to be responsible as well.
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Fill this form CAREFULLY. Along with the ENROLLMENT CHARGES and accompanied with a RECENT PASSPORT SIZE PHOTOGRAPH mail it to 'address for correspondence' to enroll for 'TRAINING PROGRAMS'. |
| Name | :_________________________ | Tel. No.:____________ |
| Age | :_________________________ | Fax :______________ |
| Address | :_________________________ | E-mail :____________ |
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Duration in practice |
:_________________________ |
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your reason for joining this ‘Training Program’?
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I have read the enrolment form thoroughly and I agree to be committed. Kindly enroll me for the ‘Training Programs’ in ‘Classical Homoeopathy’. Foundation Training Program: $ 1200 (one thousand two hundred U.S. Dollars) Advanced Training Program : $ 600 (six hundred U.S. Dollars) ______________________________________________________________________ Total : $1800 (one thousand eight hundred U.S. Dollars)
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Yours sincerely,
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(Signature) Date: |