.

All fields on this form are mandatory unless otherwise stated

CONTACT DETAILS:

First Name:

Last Name:

Position:

Email:

Organisation Name:

Trading Address including Zip/Post Code:

Country:

Website:

Telephone Number:

Skype id (optional):

Social media:

Registered Office Address including Zip/Post Code and Country:
where your registered office address is the same as your trading address, please enter ‘same as trading address’

APPLICATION FORM:

I am applying as
select one option:
.
If you are not the originating organisation
select one option:

I am applying for
select one option:

Courses
Please list all your training courses
Please enter 'none' if you do not run training courses or you do not run a training course at the relevant accreditation level
If you are not sure of the accreditation level, please enter your course name(s) in the 'not sure' box below.

Level 4 - Accredited Short Course (IIC&M)

Level 4 - Advanced - Accredited Short Course (IIC&M)

Level 5 - Accredited Foundation Training Course (IIC&M)

Level 6 - Accredited Training Course (IIC&M)

Level 7 - Accredited Full Training Course (IIC&M)

Workshops
Please list all your workshops.
Please enter 'none' if you do not run workshops.
If you are not sure of the accreditation level, please enter your workshop name(s) in the 'not sure' box below.

Level 3 - Accredited Workshop (IIC&M)

Not sure
Please list any courses or workshops where you are not sure of their accreditation level.
Please enter 'none' if you have no further courses or workshops to enter.

Other Relevant Information
please enter ‘none’ if you have no further relevant information to share

ADDITIONAL INFORMATION:

My course
.
If your course/workshop is accredited by another body, please enter the relevant information below::
- Name of the Body (optional):
- Accreditation/Credential level (optional):

Please send me:

Please

a copy of the Explanatory Notes.

Payment:

Additional Optional Information (optional):