Online Registration
& Booking

Online Registration and Booking for
Medical Accupuncture and Dry Needling Modules 1 & 2


To join one of our courses please fill in the booking form below - all the information we request is essential for administration purposes. You will then be directed to our secure payment gateway to make your payment.

payment

Full Name:
Email:
Contact Number:
Date of Birth:
Physical Disabilities:
Please state any physical disabilities or recurring illness
Learning Disabilities:
Please indicate whether there are any reasons you may wish to request reasonable adjustments in either the delivery of, or assessments related to our course - e.g. dyslexia, sight impairment, physical disability, etc.
Yes No
Course Start Date
for Module 1:
Course Start Date
for Module 2:
Payment Option:
Attach File:
Please attach a scanned copy of your qualification.
Please note - Your application will not be processed until this has been received.

Total to Pay:GBP £

Terms:I have read and accepted your Terms & Conditions and Refunds Policy

Payment Method:
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Upcoming Course Dates

 

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