ENROLMENT FORM
Please attach a passport size photograph and send the completed form to:
Three Treasures School of Traditional Chinese Medicine
24 Stoke Road, Taunton, Somerset, TA1 3EJ
(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 massage and/or Traditional Chinese Medicine? Yes/No (please delete as applicable)
If YES please enter a description below:
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 Tuina Diploma Course and am applying for a place.
I declare that I am fit enough to perform both massage and Chi Gung exercises. .
______________________________ ______/ ______/ ___
(Signed) (Date)
