Application Form


		Application Form Before completing this form you should have: Reviewed all of the details regarding the course or your choice. Ensured that you have all the entry requirements for the course of your choice You have read the Additional Information and Costs Here. Read the Terms and Conditions Here

	Personal Details

Name:

Please insert your name as you would like it to appear on your diploma

Address:

Email Address:

Phone Number:

Mobile Number:

Date of Birth:

Next of Kin:

Next of Kin Phone Number:

Educational Details

Highest Level of Education:

Occupation

Do you hold a qualification in any complementary therapy?

Why are you interested in enrolling for the course?

How did you hear about us?

Health Details

If you suffer from any ongoing illness or injury, please give full details here.:

Declaration by the Applicant:

Your signature indicates that the information you have provided is true and complete and that you have read, understood and agreed to be bound by the terms and conditions of the Institute.

Signature: ______________________________________ Date: ________________________________


	PLEASE PRINT THIS FORM and return with your deposit of €600, by online payment here, or by postal order, bank draft, or cheque,made payable to The Institute of Massage and Sports Therapy to: Programme Director, Institute of Massage and Sports Therapy Ltd., 6 & 7, The Square, Annacotty, Co. Limerick. We look forward to meeting you.


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