Registration Form
NAME:_______________________________________________________________
ADDRESS:____________________________________________________________
_____________________________________________________________________
Country: _______________
Zip/Post Code: __________________ TEL.NO: (inc code) _______________________
Email: _____________________________
If you wish to attach a Curriculum Vitae, then please do so.br>
This course is to familarise you with the main essences from Green Man and to help you
gain the Practitioner Diploma.
Payment:(Exchange rates will vary)
Payment by Visa/MasterCard/Maestro
Name on card:
Card Number: ...
./ .
./
/ ..
.
Expiry date:
./
.
Last 3 digits on signing strip:
..
Issue Number (Maestro)
I wish to pay: *£90 for registration and Module 1(or Non-UK equivalent)
or *£330 for registration and Modules 1-6 and a further one of my choice
(or equivalent for Non-UK) as I already have an A&P qualification
or *£400 for registration and Modules 1-6 and a further one of my choice, plus Anatomy & Physiology
(or equivalent for Non-UK)
Module 2 will be released only on completion of Module 1. If you decide to pay-as-you-go, each module 2-10
costs £40, but you only need to complete 6 of these.
The total cost of the diploma course is £330(or Non-UK equivalent) without A&P
or £405 (or Non-UK equivalent) with A&P.
* Please delete as appropriate and sign at the bottom of this form to confirm the amount MCS can process by card.
Sterling Cheques made payable to MCS please
or you can pay using our secure, online system
"www.greenmanshop.co.uk" or send funds via PayPal to info@mcscourses.co.uk and email MCS your address and other details for this form.
Essence Choise for Module 1
Please indicate here your essences choice for Module 1 (Choose 4)
(information about the trees is on the shop site (www.greenmanshop.co.uk) or the green man site (www.greenmanessences.com)
Bay,
Blackthorn,
Great Sallow,
Hornbeam,
Juniper,
Medlar,
Monkey Puzzle,
Mulberry,
Oak,
Persian Ironwood,
Plum,
Red Oak,
Spindle,
Sweet Chestnut,
Tree of Heaven,
Yew.
I confirm that I have read and understood the Booking Terms and Conditions explained in the accompanying sheet and agree to them.
Signature___________________________________ Name (please print)
Date:
Please return to: MCS, PO Box 6, Exminster, Exeter, Devon, UK EX6 8YE,
Tel: +44 (0) 1392 832005
© 2010 MCS