Your details

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Mr Mrs Miss Ms Dr Prof

1st name    

Middle name    

Surname   

Address 1st line    

Address 2nd line    

   Address 3rd line     

Town     

Post code    

Sex    Male Female

Date of birth 　  month 01 02 03 04 05 06 07 08 09 10 11 12   date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      year

UK resident    Yes   No

if No, Nationality   

Tel (work)   

Tel (home)    

Mobile    

Email   

Occupation   

＊You must fill in daytime contact number.

Courses

Please tick the appropriate boxes.（2 or more curses can be accepted)  

Diploma in Holistic Massage* is the foundation course for complementary therapy.

Students must include this Diploma course for enrolment.

  Diploma in Holistic Massage  *                

   Diploma in Aromatherapy

   Diploma in Reflexology

   Diploma in On Site Massage

   Diploma in Indian Head Massage

Total Courses 　 1 2 3 4 5 　

Payment

Please tick the appropriate box.

Cash                            Please bring it to ELT. (DO NOT send cash by post).

　　　　　　　　　　　　　Our office is open 9.00-17.00, Monday to Friday, 9.00-12.00 on Saturday.　

Travellers cheque       As  above.

Cheque                       Bring to our office or send by post.

　　　　　　　　　　　　　Cheque payable to ELT.

　　　　　　　　　　　　　Send to ELT,  32 North End Road,  Golders Green,  London NW11 7PT

Debit card                 When we confirm your entry by phone, please supply details.

Credit card                 When we confirm your entry by phone, please supply details. (3% fee)

Please read carefully before submitting your application