Name * First Name Last Name DOB MM DD YYYY Gender Male Female Non-defined Prefer not to say Ethnicity (how you regard yourself) Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email How did you hear about this course? Special learning requirements Please inform us of any special learning requirements you have so we can adapt the course delivery to suite your needs the best we can. None English as a second language Dyslexia Audio impairment Visual impairment Physical impairment Other Other If you clicked other please give us more information here, Have you done any other training with us? Please tell us a little bit about what your purpose is in doing this course. It doesn't have to be a grand plan - just an idea of what your aim might be. Payment Please tick your preferred payment option. Payment in full $1050. By instalment: $450 paid on registration then 2 further instalments of $300 when you submit assignment 3, and 5. Thank you for your registration for the Anatomy and Physiology distance learning course. To make your payment please use the following account: Holistic Health Training Ltd 03-0187-0097040-00Please put your surname and A&P as a reference. A refund is available within 8 days of taking the amtu will receive a receipt with your course materials. Anatomy and Physiology Registration Form
