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International Siddha Vaidya Institute / www.kitchen-pharmacy.com

Thiruvananthapuram, Kerala, India                

Name Date

Address Phone

               Country

e-mail:  

 

Class enrollment and preferred dates (Please mark your desired classes)

March 15 – 30, 2008

Pharmacy Basic

April 15 – 30, 2008

Pharmacy Basic

May 20 – 30, 2008

Ela Kizhi (Kaya Regeneration Therapy) and Siddha Massage

June 15 – 30, 2008

Siddha and Ayurvedic Spa Therapies and Southern Kerala Cooking

July 15 – 30, 2008

Pharmacy Basic

August 4 – 18, 2008

Pharmacy Intermediate

Do you wish to be contacted either by e-mail regarding any upcoming classes or trainings?  Yes No

Do you have any food sensitivities/mobility requests? YesNo     

 

Please list:

Emergency Contact Information

Name Relationship

Address Phone

               Country

 

Experience in Ayurveda/Siddha Vaidya/Naturopathy  (Please include hours of training)

 

 

 

 

 

 

Form of Payment: Cash, Traveler's Cheque, and  Bank Transfer

 

A non-refundable minimum deposit of  INR 5000 must be made to hold your space in our classes.

  

 

International Siddha Vaidya Institute, where excellence in information parallels therapeutic results.