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Any problems please contact us on 0161 221 2673

Personal Details

Dr/Mr/Mrs/Miss/Ms (*)

Title
Christian Name (this will appear on Certificates) (*)

Christian Name
Surname (This will appear on Certificates) (*)

Surname
Address 1 (*)

1st line of address
Address 2

2nd line of address
Town (*)

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Home Phone

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Mobile Phone

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DOB
Nationality eg British (*)

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Ethnic Origin eg White (*)

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Other Information

How did you hear about us? (*)
RecommendationGoogleYahooMSNVTCT WebsiteHealthy Pages websiteWorldwide Health websiteHolistic Local websiteBeauty Guild websiteVenue SignsTop SanteFHTOther websiteOther magazineOther
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Detail any relevant health issues

General Health
Specific Requirements eg Learning needs

Specific Requirements Please indicate any specific learning needs you may have, including any disabilities, in order that we may endeavour to provide for your requirements. If we have any queries we will contact you

Course Bookings

Please choose your course (*)
Aug 10 CHESTERSept 1 eveSept 20Nov 13Jan 29 2011Feb 2 2011Apr 11 2011June 25 2011Sept 12 2011Sept 28 2011Oct 29 2011
Course Date?
Please state your entry qualifications/previous experience for eligibility to this course (*)

Entry Requirements
VTCT Registration Number

VTCT Registration Number Please enter your VTCT number, if you are already registered.
If you are VTCT registered are your health & safety units less than 3 years old? (*)
yes no
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Terms & Conditions

Please read our terms and conditions: Massage of Course Booking Terms & Conditions

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How would you like to pay? (*)
Credit/Debit Card (via Google Checkout or Paypal)
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Instalment Plan

Please choose payment method

Once you submit this form, you will be directed to the payment page which will give you details for your chosen payment method or allow you to pay via credit/debit card.
CMA will then send out all your confirmation & preparation details




  


All personal information received by Orchid Indulgence Ltd will be treated in the strictest confidence, and in full accordance with the Data Protection Act, 1998.