WOMENS
WATERWORKS

Curing Incontinence ...

 
A world-wide best seller
by Dr Pauline Chiarelli
         
 

Workshop Booking Form

Please complete the Form below to book a place in a workshop. Workshops often fill quickly, so confirm you have a place before booking airlines etc.

 

Please Note: This Form may be printed if you prefer
to fax or post your workshop reservation.

 

 

Or complete online Booking Form below.

Name(s) (include more than one name here if from the same practice:

Practice Name (if applicable):

Postal address:

Postal Address2

Town:

State:
Postcode

Email contact:

Phone Contact:

Select Workshop
& Preferred Date
(If you wish to attend a workshop please select the date you wish to attend) :
 

Female Pelvic Floor Workshop

Male Pelvic Floor Workshop

How would you
like to pay for your
workshop(s)?

Bank Deposit
Credit Card over the phone
Credit Card by Fax or Post

 
 

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