Therapy directory Registration Form

Please note that SECTION1 below is entirely free of charge but only your name, town and type of clinic will be listed in the directory. If you wish to have your contact details and various additional information listed then please fill out the appropriate sections of this page and you will be taken to PayPal out credit/debit card payment gateway. Alternatively, you can simply fill this form in, print it out and post it with a cheque made out to Therapy Directory to Therapy Directory PO Box 7419 Annan DG12 5WX.

SECTION1 - FREE Registration
Centre Name
Last name		First name
Address		Position/Title
Town		Region County	Region County
Post Code		Country	United Kingdom
What best describes your centre /Clinic	Please Choose .... Alternative healthBody and soulComplementary healthCounselling ServiceHealth and fitnessHealth centreHealthy livingInformation/AdviceMedical centreMind, body and soulNatural healthSalonTraining CentreTraining InstitutionWell being

SECTION2 - Contact information £20 Annual Registration Fee
Number of therapists in team		Website
Phone		Mobile
FAX		Email
Opening times
Fees
Details of practice
Therapies Provided
Conditions Treated
Therapists Deatils
Other Information

SECTION4 - Additional Therapy Headings - £2 per additional heading Annual Registration Fee
Please choose .... Therapy1 - No selectionAlternative healthComplementary healthNatural healthHealth centreHealth and fitnessHealthy livingMedical centreWell beingBody and soulMind, body and soulSalonInformation/AdviceCounselling ServiceTraining CentreTraining Institution Therapy2 - No selectionAlternative healthComplementary healthNatural healthHealth centreHealth and fitnessHealthy livingMedical centreWell beingBody and soulMind, body and soulSalonInformation/AdviceCounselling ServiceTraining CentreTraining Institution Therapy3 - No selectionAlternative healthComplementary healthNatural healthHealth centreHealth and fitnessHealthy livingMedical centreWell beingBody and soulMind, body and soulSalonInformation/AdviceCounselling ServiceTraining CentreTraining Institution Therapy4 - No selectionAlternative healthComplementary healthNatural healthHealth centreHealth and fitnessHealthy livingMedical centreWell beingBody and soulMind, body and soulSalonInformation/AdviceCounselling ServiceTraining CentreTraining Institution Therapy5 - No selectionAlternative healthComplementary healthNatural healthHealth centreHealth and fitnessHealthy livingMedical centreWell beingBody and soulMind, body and soulSalonInformation/AdviceCounselling ServiceTraining CentreTraining Institution	i If you are an organization that is primarily listed as a medical centre but also operates a counselling or training service, you can register all your information under each additional heading for £2 per additional heading. To choose up to five additional therapies, use the lists opposite.