Brain Training Registration Form

Brain Training Programme Registration

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Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
NRIC/Passport/Work-Pass Number*
Highest Qualification Level*
Phone Number*
Format: (000) 000-0000.
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Your WhatsApp/Viber/WeChat/Facebook/Other ID*
E-mail*
example@example.com
Profession:*
Income Range:*
How did you hear about us?*
Other*

Brain Training Programme*

Brain Training Programme for Children (1 Term)

$650.00SGD Quantity
Item subtotal:$0.00SGD

Brain Training Programme for Adolescent, Adult, Elderly (1 Term)

$650.00SGD Quantity
Item subtotal:$0.00SGD

Parent/Client monthly 45 minutes consultation (Per Term – 3 months

$360.00SGD Quantity

Report

$300.00SGD Quantity

Registration Fee

$150.00SGD

Subtotal

$0.00SGD

Tax

$0.00SGD

Shipping

$0.00SGD

Total

$0.00SGD

Any specific concerns you wish to share?
YesMaybeNo
**By using this service provided by Rogerian Psychology Centre, you agree to abide by the following Terms & Conditions:
1. This is an Enrichment Programme, and we do not make promises of increased in cognitive performance and actual results will vary due to individual differences and various factors. Outcome of training programmes are pegged to the current scientific data published.
2. There is no refund once registration have been made.
3. There is no rescheduling of missed training sessions unless MC is provided - exceptions apply on case to case basis and the centre reserves the rights on rescheduling decisions.
4. By clicking submit, you acknowledge and agree to be binded by the above terms and conditions.
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Brain Training Programme Registration