Apply_Fax/Mail

Application Form for "Fax/Mail"

Please print out this form and fill out then Fax or Mail to the address below.

Date of application: (dd/mm/yyyy)
　　　　　　　　 / /

Applicant name: (Please type Mr. or Ms. on your name)
　　　　　　　　　

Date of birth: (dd/mm/yyyy)
　　　　　　　　 / /
Age:
　　　　　　　　 years

Mail Address:

Contactable place (if any)
　　　　 E-mail =
　Hand Phone =
　　Telephone =
　　　　　　 Fax =

Course applied for:
　　　　　　　　　　Thai Traditional Massage (Body) Basic course (30 hrs)
　　　　　　　　　　Thai Traditional Massage (Body) Middle grade course (30 hrs)
　　　　　　　　　　Thai Traditional Massage (Body) Advanced course (60 hrs)
　　　　　　　　　　Thai Traditional Massage (Advanced) Herbal massage course (30 hrs)
　　　　　　　　　　Thai Traditional Massage Ayurvedic specialist course (60 hrs)
　　　　　　　　　　Thai Traditional Massage Ayurvedic specialist course (120 hrs)
　　　　　　　　　　Foot Massage Basic course (18 hrs)
　　　　　　　　　　Datton Basic course (12 hrs)

Date of start studying desired: (dd/mm/yyyy)
　　　　　　　　　 / / 　　　　　　

Parent name: Father's name=　Mr.
　　　　　　　　　Mother's name= Ms.

Place to stay in Bangkok with name & telephone #: (Please fill for your safty)

Phussapa Thai Massage School
http://www.thaimassage-bangkok.com/
25/8 Soi 26, Sukhumvit Rd.
Klongtan Klongtoei Bangkok 10110 Thailand

Fax from inside of Thailand = 0-2204-2924
Fax from outside of Thailand = +66-2204-2924

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