Application Form - The National College Of Holistic Medicine

This entitles you to your ICHM Identity Card,
access to our Help-Line
and all other membership privileges.

To apply for membership.
please print this form out
(or send your details on a separate sheet of paper),
enter your details,
and return it together with:

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	your cheque for £50 (GBP)
	a passport size photo of yourself (for your I.D. Card)
	photocopies of all relevant certificates & diplomas.

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Send To: International College of Holistic Medicine,
43 Southampton Road
Ringwood
Hampshire
BH24 1HE
England
Email: nchm@uk2.net

You should receive your Membership Pack in about three weeks.

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Your Title (Mr. / Mrs. / Miss / Ms. / Dr. etc.):
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Your name:
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Address (line 1):
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Address (line 2):
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Town or City:
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County, Province or State:
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Country:
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Post Code or Zip Code:
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Telephone number:
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Fax Number::
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E~mail Address:
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What Relevant Qualifications Do You Hold?
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Age:
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Sex (M / F)
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What area will you be working in?
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Do you have Practitioner Insurance? If so, please enter the details in the <comments> box below.
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COMMENTS & ADDITIONAL INFORMATION:

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