Course Application Basket

Before applying for a course, please read our Terms and Conditions and Booking Information.

If possible, please enter your work address in the application form below, as this helps reduce our costs when mailing course joining instructions to you.

Academic Modules
On-line applications are currently not available for our academic modules; please click here for a downloadable module application form.

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Your Details
	First Name *
	Surname *
	Work Address Line 1 *
	Work Address Line 2 *
	Work Address Line 3 *
	Town *
	County
	Postcode *
?	Email Address *
?	Course Title *
?	Course Start Date *
?	Mailing Address Line 1
	Mailing Address Line 2
	Mailing Address Line 3
	Town
	County
	Postcode
	Work Telephone Number *
	Home Telephone Number
	Mobile
	Email Address *
	Manager Name *
	Manager Job Title *
When you create a posting called Termsandconditions in the channel www.somerset-hospice.org.uk > Academy > FormConfig-courseapplicationbasket using the Web Form Extra Content template, the contents of that posting will appear here.
	I have read the Terms and Conditions and agree with them *

	By submitting this application I confirm that the manager named above has granted study leave for me to attend, and that I agree to the terms and conditions. *