Managing Anxiety & Panic Disorder Course Registration Form*

Coping with Anxiety during Covid-19 Course Registration Form

Fill out the form carefully for registration. Courses are being temporarily run remotely (via Zoom). If numbers exceed places, further courses will be run.
Name *

First Name Last Name
Birth Date

Day Month Year
Address *

Street Address

Street Address Line 2

City County

Post Code
E-mail *
example@example.com
Mobile Number *
Phone Number
Work Number
Organisation (up to 3 people from the same organisation can register) *
Additional Comments
Should be Empty:

Coping with Anxiety during Covid-19 Course Registration Form