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Course *

Course name

Name *

First

Last

Telephone *

Telephone number

D.O.B. *

* Numbers only

Email *

Email

Confirm Email

Home address *

Home address

Postcode *

Name & address to be invoiced (if different from above)

Do you have any access or communication requirements, please specify below :

Please specify any previous counselling qualifications (COSCA modules completed) include dates and institution or examining body:

Supporting statement *

Course Fees & booking conditions (Please read)

How did you hear about GCA?

Would you like to be informed of any future training, events or news?

You will remain on our mailing list, and receive our newsletter and emails about our events and training courses.

Privacy *

I have understood the booking conditions.
By using this form you agree with the storage and handling of your data by GCA. Read our full Privacy policy at www.glasgowcouncilonalcohol.org/privacy-policy/

Signature *