Acupressure Health Care System

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Course Name *

Name *

Date of Birth

Age

Gender

Email *

Password

Blood Group

Religion

Caste

Education

Additional Qualification

Profession / Occupation

Experience

Aadhar No

Website / FB / Social Media

Permanent Address * (With Landmark)

Country

State/Province

Pin/ Zip Code

City / District

Nationality

Correspondence
(Current) Address

Same as Permanent Address Diffrent from Permanent Address

Mobile No *

Whatsapp No *

Refered by

Recommended By

Medium

Identity Card

If Required $10 or 500 Extra

Extra Service

Extra Service $20 or 1000 Rs

Payment Mode

Remark / Review

Material/Certificate Send By

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