Workshop Certification

Workshop Certification Form
After you submit this form you will be directed to Paypal to pay our £20 certification fee which can be paid by either PayPal, Visa or Mastercard. Your certificate will be posted within 2 weeks.
Todays date

DayMonthYear
Full Name*

First NameLast Name
Home address*
Postcode*
Clinic address with postcode
Phone Number*
E-mail*
Website
Previous relevant qualifications in complementary or western medicine*
Name of workshop*
Length of Course*
Course Tutors Name*
End of course or examination date*
Enter the message as it's shown*
Should be Empty:

Workshop Certification Form