APPLICATION FORM

APPLICATION FORM FOR COURSES AND OPEN TRAINING CLASSES

You have to fill in all the fields, otherwise the form will not be sent!

I wish to sign up to:

Courses and classes. Write name and date of the course you will registrate to. *

*

PERSONAL INFORMATION:
Name	*
Date of birth	*
Male or Female
Address	*
Zip code City	* *
Country	*
Phone	*
Mobile phone
E-mail	*
Write here about your motivation and experience.	*

From where do you know about Nordic Butoh or Open Training?	*

Fill in this form, push SEND and your transmission will automatically be registered at Nordic School of Butoh. Or print the page and send it by post to: Nordic School of Butoh, Bådsmandstræde 43, DK-1407 Copenhagen. (As we might be away for periodes, we prefer that you to use online application or e- mail) If you do not hear from us after eight days, please phone. Nordic Butoh Post: Bådsmandstræde 43, DK-1407 Copenhagen Farm in Denmark: Bækkelund, Bolbyvej7, DK 3782 Klemensker Cell Phone: +45 2665 5605,E-mail: i n f o @ n o r d i c b u t o h . d k www.nordicbutoh.dk

© Nordic School of Butoh 2004