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:

Current Occupation:

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 Level 4 Sports Massage qualification or similar. This award is a pre-requisite to attend the course. 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:

Pay: