Application form

Please circle relevant course date

*Title

*Full Name

*DOB

*Correspondence Address

*E mail

*Phone

*Mobile

University degree

Medical (dental, veterinary) degree

Biomedical Sciences degree

*Describe University course (Years, University Name)

*Other relevant course(s)

*Seminars and short courses

*Certificate of Membership (state which registering body and forward photocopy of Certificate)

Doctor, dentist, veterinary surgeon

Pharmacist, biochemistn

Osteopaths, chiropractors

Naturopath, complementary medicine

Biomedical research (including postgraduate courses)

Psychologist, psychotherapist

*Medical Speciality

*Royal College

*Other medical experience (technicians, podiatrists, biochemist..etc, as indicated in Professions Ancillary to Medicine Lists (Department of Health)

*Complementary medicine experience

*Medical experience (medical nurse and medical auxiliary professions) describe duties and years of practice

All cheques payable to the Biomedic Foundation (the Charity) I would like to pay full fee of £2,500.00

I would like to pay no interest, by ten monthly instalments of £250.00

My course fee is financed by Health Authority or employer

*Name and telephone/E-mail of the financing body