NADA Acudetox Specialist Course Application
Please contact Warren Whitfield on +27790663382 after you have completed this form. More information will be emailed to you after submission.
Email : info @ acudetox.co.za
Next course date
*
select nearest course date
Private Tuition / By Pre Arrangement Only
Maximum 10 students per course.
Our banking details
Acudetox S.A.- Bank > Nedbank - Account Number > 1913445887 - Branch Code > 191305
Copy our banking details in order to make your EFT payment after you book your course.
Full payment is due on registration application. Because there are only 10 students per course, payment is required in advance to ensure your seat.
Your full names
*
Physical address
*
Postal address
*
Identity number
*
Email
*
Contact tel
*
Mobile number
*
Fax number
*
Age
*
Sex
*
select
male
female
Have you had any formal medical training?
*
select
no
yes
Have you had any alternative medical training?
*
select
no
yes
Why do you want to learn this profession?
*
Are you currently employed?
*
select
no
yes
Current state of health
*
Are you a carrier of any infectious diseases?
*
select
no
yes
If so what?
*
The information you disclose here will be kept completely private and will in no way affect your eligibility to attend the course or qualify as an ADS.
Can you attend 2 hours a day, evenings only
for one week, or 3 full Saturdays in a row?
*
select
no
yes
Will you be able to handle inserting
acupuncture needles?
*
select
no
yes
Any message?
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