The Modern School of
Ancient Therapies |
Surname: | Title: Mrs/Miss/Mr/Ms | ||
First Names: | Date of Birth: | ||
Address: | Telephone No: | ||
Address: | Mobile No: | ||
Town/City: | Email Address: | ||
Postcode: | Occupation: |
Reasons for application? | |
Where did you hear about us? | |
Do you have any mental or physical challenges? | |
Who is funding the course? i.e. Self/Employer/College |
Please state below which courses and dates you wish to apply for:
I have enclosed a non-refundable deposit of £50 per course | |
I have enclosed the full balance of the course | |
I require a kit and enclose full payment |
The total cost for course £
Please note: We accept cash, cheques BACS and IBAN payments. We do not
accept Credit or Debit cards. Please make cheques payable to The Modern School
of Ancient Therapies. Payments by BACS 090666 42112278 IBAN
GB60ABBY09066642112278
Thank you.
Please print the completed form then sign and date it and send
to:
The Modern School of
Ancient-Therapies, 10 Duck Street, Clitheroe, Lancashire, England BB7 1LP
Signed: Dated: