Active Health Application Form
In the first instance, please fill out the application form and send it to us.

We will send you an email with a PayPal link that you can then use to pay the fees.

Thank you for your interest in our course and we hope to live up to your expectations of the course.

Thank you

James

Full Name *
Fill in your first name and surname
Your answer
Address
Full address including country
Your answer
Date of Birth *
Data should be entered month/day/year
MM
/
DD
/
YYYY
Email address *
Your answer
Mobile *
Your answer
Phone (landline)
if you have one, mobile preferred
Your answer
Qualifications *
Please list qualifications relevant to this course. plus list college name in brackets after qualification e.g. Diploma in Acupuncture (University of London) Year:1996
Your answer
Work History
Please list your relevant work history and experience in relation to the course
Your answer
Professional Indemnity Insurance
If you are applying for a Postgrad course, please inform us if you hold currant Professional Indemnity Insurance and with which provider or group scheme.
Your answer
Reason for studying this course
Your answer
Any other information you feel may assist us
Your answer
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