The Kushi Institute of Europe
Weteringschans 65
1017RX Amsterdam, NL
Tel.: +31 (0)20 625 75 13 Fax.: +31 (0)20 622 73 20
E-mail:

Registration Form

3 Fascinating Weekends

Please mark X near your selected course:

3 Study Weekends with Adelbert and Wieke Nelissen
Nine Star Ki Astrology
February 2 - 5, 2012
€ 295 (in Amsterdam) / 2nd person, 20% discount
€ 236
The Way to Health, Vitality & Strength
March 30 - April 1, 2012
€ 275 (in Amsterdam) / 2nd person, 20% discount
€ 220
The 5 Transformations
April 20 - 22, 2012
€ 275 (in Amsterdam) / 2nd person, 20% discount
€ 220

Prices include: classes, study material, 3 meals a day, free accommodation (limited availability) in a 2-3 person room
Special discounts: in combination with 2 or more of the 3 study weekends 20% discount

1st person Please write in capitals

Mr. / Mrs. / Miss
First name:
Family name:
Date of birth:
Address:
Postal code:
Town:
Country:
Tel. home:
Tel. work:
Fax:
E-mail:

2nd person

Mr. / Mrs. / Miss
First name:
Family name:
Date of birth:
Address:
Postal code:
Town:
Country:
Tel. home:
Tel. work:
E-mail:
Language

All lessons will be given in English

I require translation into:

There are additional costs on this translation service.

Please contact our office for additional information.

Accommodation
We provide free accommodations for a limited amount of students. When we reach the limit, we can help to find other options – hotels, hostels, relatives in near surrounding. Extra costs need to be count with.
I want accommodation in a 2-3 person room
I do not need accommodation
Payment
I am making the required
non-refundable down payment of
€ 50,- per person per weekend: / Total:
€
I am paying the total course(s) fee / Total:
€

Method of payment no cheques are accepted

Bank Transfer
Bank ABN-AMRO Amsterdam
acct. no. 49.86.08.468
swift code: ABNANL2A
IBAN: NL77ABNA0498608468
Credit card / Visa / MasterCard
Credit card number:
Expiration date:
CVC - last 3 digits on the backside of the card:
Card Holder Name:
Date:
Signature:

Please send the completed form to us by email, fax or post.

We reserve the right to change dates and prices

In case of cancellation, more than 2 weeks prior to a course, full refund is granted except for the (non-refundable) down payment. Less than two weeks prior to a course, or if interrupting a course, no refund is possible.

The Kushi Institute is not a medical institution. The programmes and services of the Kushi Institute as well as the information provided on our web pages are for educational purposes. They are not meant as medical advice nor to take the place of a personal consultation, medical diagnosis or medical treatment.