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Practitioners Registration

The private practitioners section is available once your yearly fee of 15 Eur is paid. You can wire the money on the account mentionned below or use Paypal.

Please fill in the form below. Depending on your selection, it will be immediately published on the public list of names according to your desire.

Bank Account :

Recipient:
CIC Asbl
192 Domaine de Bellevue
6940 Petite Somme

Banque du Brabant - BKCP
Avenue Du Monument 8
6900 Marche-En-Famenne
Belgium

Account n°: 114-2609784-30
IBAN BE15 1142 6097 8430
BIC BKCPBEB1BKB

Commmunication: Membership + year.

Please fill in th form below. Fields with * are compulsory.


Personal Data

Name*

Surname*
Adres*
Votre Adresse de résidence
Zip Code *
City*
Country*
Phone
Mobile
Personal Web Site
(without http://)
www.exemple.com

Login Details

User name *
Email*
**correct Email formats only..
Password*
** 5 chars minimum..
Re-enter Password *

Infos Practitioners

I want to see my name on the Practitioners public lists
Will work
I'm a Frequencies of brilliance Practitioner
I'm an Amanae Practitioner
Present level of FoB * Follow up?
Teacher of the last level of FOB *
Year of this course *
Land of the course
Amanae brainwork level
Teacher
Year of the last course
Country
I'm a Public Manna Teacher
Year of the course
Country of he course
I want to appear in the list of Public Manna teachers
I followed FOB 3
Teacher
I followed a Manna Public Program
Teacher
Country
Spoken Languages

FR EN NL ES
PT DE IT HW
Other

Questions and remarks
Security

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