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AMSPAR Medical Terminology Enrolment form
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Which Medical Terminology course are you enrolling for?
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L2 Award in Medical Terminology
L3 Certificate in Medical Terminology
Title
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First Name
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Your answer
Last Name
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Your answer
Address
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Your answer
Postcode
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Your answer
Telephone Number
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E-mail
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Your answer
Date of Birth
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Gender
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Male
Female
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Do you consider yourself to have any learning difficulties, health problems or long-term disability?
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If you selected yes to the above question, please describe your
learning difficulties, health problems or long-term disability (this is optional and the information is only used to help us to better cater to your needs)
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Where did you find our course?
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Google
Government Website
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Current Occupation
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Should the course invoice be made out to an individual (yourself or another) or to an employer?
(If your employer is paying for the course you will need to complete the employer details below)
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Individual
Employer
Employers Name
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Employers Address
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Employers Postcode
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Employers Telephone Number
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How would you/your employer wish to pay for this course?
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Debit/Credit card
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By invoice
Do you wish to pay for this course upfront or in instalments?
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Full cost
Instalments
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