Application Form
Please send the completed form to:
Three Treasures School of Traditional Chinese Medicine
60 Fore Street, North Petherton, Bridgwater
Somerset TA6 6QA
(PLEASE COMPLETE THE FORM USING BLOCK CAPITALS)
Your First Name_____________________________________
Your Last Name_____________________________________
Title (Mr. Miss, Mrs, Dr etc)___________Date of Birth___/____/___
Address___________________________________________________
__________________________________________________________
Post Code_______________Telephone No._____________________
Email address:__________________________________________________
Do have any previous experience or qualifications in Traditional Chinese Medicine? Yes/No (please delete as applicable) If YES please enter a description below:
Are you applying for exemption from TCM Core Studies? Yes/No
Do you have any qualifications/ experience in Anatomy and Physiology?
Yes/No (please delete as applicable)
If YES please give information here:
I have read and understood the details of the Acupuncture Certificate Course and am applying for a place on the courses
I declare that I am fit and healthy enough to perform Acupuncture treatments and Qigong exercises.
. I understand that confirmation of fees due will be sent to me with the letter of acceptance onto the Course.
_______________________________ ___/ ___/ ______
(Signed) (Date)
If you have not been on one of our previous courses please attach a passport size photograph
