Please fill out the form below to register a candidate for one of our courses.
Which course would you like to enrol the candidate onto? ---Pharmacy Assistant CourseMedicines Counter Assistant Plus Stock Control Course
Candidate Name:*
Candidate Title:*
Candidate Date of Birth:*
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
Candidate Ethnicity:* ---Prefer Not To SayWhite BritishWhite IrishCaucasianBlack BritishCaribbeanAfricanAny Other Black BackgroundAsian BritishIndianPakistaniBangladeshiChineseJapanese
Supervisor (Registered Pharmacist/Technician) Name:*
Supervisor GPhC Number:*
Pharmacy Name:*
Pharmacy Address:*
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Telephone Number:*
Email Address:*
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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).
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Once you have registered and clicked on the “Submit” button, we will contact you for payment before sending out course materials.