The Mind Diet

To take part in a Mind Diet workshop please fill in this form. Once we have received the form we will contact you to confirm your place.
The total price of the workshop is £99 including a very healthy lunch at Combe Grove Manor.

First Name

Last Name

*Gender
Male
Female

	Address line 1 Address line 2 Town County Post Code

	Which date are you interested in? (please copy a date into the box) September 20th 2007 at Combe Grove Manor, Bath November 4th 2007 at Combe Grove Manor, Bath
	What do you want to gain from the Mind Diet workshop?
	What's stopping you from gaining this right now?
	What have you tried that hasn't worked?
	*Email Address
	*Confirm Email Address
	Telelphone Number
	*How did you hear about us?

	Disclaimer Click here to read disclaimer
	Cancellation of a booking is subject to the following terms: Two weeks (14 days) prior course date – no charge Less than two weeks prior the course date - total cost Disclaimer: I (the client) do assume all responsibility for my participation in The Mind Diet workshop. I am taking part with or without the approval of my doctor and do hereby assume all responsibility for my participation and any changes I make to my diet or activity level. I release The Mind Diet representatives that advise me from any liability for personal injury or other damage I may sustain whilst engaging in any programme or activity suggested by them. * I agree with the terms and conditions of this site