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please print and post to; Dublin Buddhist Centre, Liberty Corner, 5 James Joyce Street, Dublin 1 |
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| EVENT DETAILS | |||||||||
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Name of event
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Foundation Meditation Course
Yoga Course
Follow-on Meditation Course
Other: .......................................................... |
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Date
of event
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................................................................................ | Time .................................. | |||||||
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Amount |
€ ____________________Deposit/Full Payment* Please note that deposits are not refundable or transferable |
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Rate |
Full Rate Low Waged Student/Unwaged (please circle one) |
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YOUR DETAILS | ||||||||
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Name |
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Mr/Mrs/Ms*
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Address |
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Phone Num |
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PAYMENT DETAILS | ||||||||
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I enclose a cheque made out to "Dublin Buddhist Centre"
for; € .......................
please charge my credit/debit card please note that the address above must be the card holders address |
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Type of card |
Mastercard
/ Visa We cannot accept Maestro or Electron. We can only accept Laser in person, sorry. |
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Valid |
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Expiry Date |
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Card number |
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Please charge the amount of € ............................
to my card. |
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................................................................ | Date ........................ | |||||||
| Please indicate how you first heard about us: (please tick) | |||||||||
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Web search (e.g. Google)