Saint Martin's College of
Physical Therapy

Course Application Form

Please print and complete this application form and return it, with a course deposit
of €500 to: Saint Martin’s College, West End Clinic, Main Street Ballincollig, Co, Cork.

Please make all cheques / bank drafts payable to Saint Martin's College.

Surname       _______________________________________Mr / Mrs / Miss / Ms

Forename(s) ____________________________________________________________

Address _______________________________________________
               _______________________________________________
               _______________________________________________
               _______________________________________________

Sex          M / F                                                                             Date of birth _________________

Nationality __________________                                                Home Phone _________________

Mobile _____________________                                                 Email _______________________


Previous training completed
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Please select the course you are applying for.

Year 1 Remedial Massage Therapy                    [ ]

Year 2 Advanced Remedial Massage Therapy  [ ]

Certificate in Manipulative Therapy                   [ ]

Diploma in Manipulative Therapy                       [ ]
           



Signed _____________________________


Saint Martin's College is committed to assisting people with special needs. Should you require any assistance to
attend the course please attach a letter stating your requirments. Every effort will be made to accommodate you.