Anatomy and Physiology for Holistic Bodyworkers Registration
Please only complete this form if you plan to pay the $200 registration fee at the end. If you want to know more about the course before registering you can complete the expression of interest form on our website, or contact HHT on olivia@hht.co.nz.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Ethnicity
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you hear about this course?
*
Please Select
Word of mouth
Internet search
Social Media
Referral
Other HHT courses
Other body work modality
Have you done other courses with us?
*
Yes
No
Do you have any special learning requirements?
*
ESOL
Dyslexia
Audio Impairment
Visual Impairment
Physical Impairment
Other
N/A
Please select the phrase that best describes you purpose for doing this course.
*
Please Select
Self Employed
Employed
Whanau/Community
Pre-requisite
Professional Development
Personal Development
Tell us a little more about your purpose for doing this course.
*
Please tick your preferred payment option
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Please Select
$200 registration fee, then three further payments of $300 at Modules One, Five and Eight.
$200 registration fee, then one payment of $900 for all modules.
Signature
*
Date
*
-
Month
-
Day
Year
Date
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