REGISTRATION FORM Instructor: Judith Johnson - email@example.com I am excited that you wish to join the EMMETT Practitioner training programme. Class sizes are limited so register early for the best chance of obtaining a place! First name (required) Last name (required) Email (required) Phone no. (required) Which course? (required) Module 1&2Module 3Module 4Module 5Module 6Module 6 ReviewClient Clinic DayBoth Module 6 Review and Client Clinic Day Course start date (required) Day 12345678910111213141516171819202122232425262728293031 Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year 202120222023 Location (required) Can you bring a massage table? (required) YesNo ADDRESS DETAILS House name / number (required) Road / street (required) Please leave this field empty. Town / City / Village (required) County (required) Postcode (required) Country (required) Please let us know below if you have any questions Course Fees EARLY BIRD OFFER Each 2-day course fee is GBP 300 ( GBP 150 if repeating) Each 1-day course fee is GBP 150 ( GBP 75 if repeating) GBP 60 deposit (GBP 30 if repeating) will be taken at the time of booking to secure your place. This is non-refundable. The course fee balance is to be paid at least 3 weeks prior to the course start date. Euro payments are accepted to the equivalent GBP value. For course fees / balance paid within 3 weeks of the course start date, a higher course fee will apply. Each 2-day course fee is GBP 340 ( GBP 170 if repeating) Each 1-day course fee is GBP 170 ( GBP 85 if repeating) Judith will respond to you shortly with payment details to secure your place. Payment options include bank transfer, cheque and in some cases PayPal for credit & debit cards. Cancellation Policy Full refunds will be given for cancellations up to 21 days prior to a workshop, minus the non-refundable deposit. 50% refunds will be given for cancellations within 20 – 2 days (48 hours) of a workshop. No refund will be given for cancellations within 48 hours of a workshop. Note: Every effort is made to ensure workshops go ahead as scheduled however, courses may be cancelled or postponed if attendance numbers are not sufficient. You may wish to seek cancellation insurance or choose refundable transport / accommodation. Under these circumstances, your course fee will be refunded. Please refer to www.emmett-uk.co.uk for the full Refund and Cancellation Policy. Privacy Statement: (Tick to give your permission) I understand that by supplying my contact details I give my permission for the course instructor to pass my contact details to EMMETT Therapies UK and Ireland (ETUK) and EMMETT Therapies Head Office so that I can be kept informed with important EMMETT Technique information. I understand I can request my details be deleted at any time. I understand my contact details will be passed to NHS Test and Trace if requested. I do not give my permission for my contact details to be passed to any other third party.