College Application to join the CMAPLEASE COMPLETE IN BLOCK CAPITALS

Complementary Medical Association, Blackcleuch, Teviothead, Hawick, Scottish Borders, TD9 0PU

NAME OF COLLEGE/SCHOOL

DISCIPLINES TAUGHT

YOUR FULL NAME(Including title, e.g. Mr, Ms, Dr etc)

YOUR JOB TITLE/ROLE

YOUR QUALIFICATIONS

PROFESSIONAL BODIESREGISTERED WITH

COLLEGE/SCHOOL ADDRESS

TELEPHONE NUMBER

FAX NUMBER

E-MAIL ADDRESS

WEBSITE ADDRESS

DATE ESTABLISHEDMONTH YEAR

FULLTIME

PARTTIME

LIST NAMES AND QUALIFICATIONS OF KEYTEACHING STAFF OVERLEAF

NAME OF EXAMINATIONBOARD (If applicable)

NO KEY TEACHING STAFF

LENGTHOF COURSE

NO. OF STUDENTS

MAXIMUM AVERAGE

POSTCODE

College Application continued

Complementary Medical Association, Blackcleuch, Teviothead, Hawick, Scottish Borders, TD9 0PU

I confirm that all the information given above is correct and authorise the CMA to make the necessary reference checksin connection with my application. Please sign, date and return this form, along with your cheque to the Complementary Medical Association, Blackcleuch, Teviothead, Hawick, Scottish Borders, TD9 0PU.

Email: info@the-cma.org.uk Web site: www.The-CMA.Org.UK Tel: 0845 129 8434

Signature: Date:

Data Protection Act 1998: I/We agree that the information provided on this form or during any telephone call, may be held oncomputer and used for customer administration, research and analysis purposes and marketing of financial and related products. Theinformation may be disclosed to third parties whose products may be of interest to me and who may hold it on computer for the abovepurposes. If you prefer not to take part in research or receive information about products and services that we offer directly, or areoffered by third parties, please tick this box:

KEY TEACHING STAFF QUALIFICATIONS