Register ‘The Relief’
First name: *
Surname: *
Male – female:
male
female
Company name: *
Profession: *
E-mail address: *
Telephone/mobile number: *
Date of birth: *
The following date i will participate the course:
(click the date and language you want to participate with)
: *
zaterdag 7 november 2009, Rotterdam. Taal: NL
ask for alternative date. Language: UK
accepting conditions
VOOR AKKOORD: *
You will confirm your participation by accepting the conditions and your company will pay €200,- in advance on the account of IDA BV in Amsterdam, number 66.82.25.262.
Fill in the next questions to prepare for the training;
How long have you been smoking?
How much do you smoke (daily)?
Have you ever stopped smoking? If yes, why did you not succeed? Which methods have you used in the past?
In what situations or at what moment do you dislike your smoking behavior?
If you consider to stop, what frightens you, where are you afraid of?
What is your greatest advantage when you quit smoking?
Questions or comments: