Enrol on a Course

Which course would you like to enrol the candidate onto?
---Pharmacy Assistant CourseMedicines Counter Assistant Plus Stock Control Course

Candidate Name: First name*

Candidate Name: Surname*

Candidate Title:*

* Required field

Candidate Email Address:*

Candidate Date of Birth:*

Candidate Gender:*
---MaleFemalePrefer Not To Say

Candidate Ethnicity:*
---Prefer Not To SayWhite BritishWhite IrishCaucasianBlack BritishCaribbeanAfricanAny Other Black BackgroundAsian BritishIndianPakistaniBangladeshiChineseJapanese

Does the candidate have a registered disability?*
NoYesPrefer Not To Say

Does the candidate require any additional support?*
If yes, someone from CIG will contact you to discuss support options.
NoYes

Supervisor (Registered Pharmacist/Technician) Name:*

Supervisor GPhC Number:*

Pharmacy Name:*

Pharmacy Address:*

Postcode:*

Telephone Number:*

Email Address:*

* Required field

Data Protection Statement:

By registering with Counter Intelligence and enrolling for courses you confirm that you have read and accepted our Terms of business (here) and our Privacy Policy (here).

I confirm my acceptance of Counter Intelligence’s Terms and Conditions and Privacy Policy.

Once you have registered and clicked on the “Submit” button, we will contact you for payment before sending out course materials.