Training Registration Form

About You

* indicates a required field.

Title*

First Name*

Middle Name(s)

Surname*

Email*

Phone*

You will need to submit your professional registration number before being accepted on a course.

If you do not have a professional registration number, please contact the office.

Professional Registration Number

Registration Type
(Please select one of the options below)

Professional Status
(Please select one of the options below) Allied Health ProfessionalDoctorOtherStudent

Place of Work*

Job Title*

Previous Medical Training (or other)

Membership of Other Organisations

Where did you hear about the IPM?

Your Address

Address Type

Address

Country*

Your Consent Preferences

The IPM uses email as its primary method of communication to talk to you about training, exams, accounts, events and newsletters. We do not pass your information to 3rd parties. In accordance with GDPR legislation, we would like your permission to contact you via email. We may also use other forms of communication to contact you about your IPM account and training.

Please check this box if you would like to subscribe to the IPM Mailing List.
Check this box to subscribe or uncheck this box to opt-out.

Email Consent*

Phone Consent*

Postal Consent*

SMS Consent*

Introductory Group Email Consent*

Please confirm that you agree to be copied into the Introductory Course emails (approximately 10 attendees).
The emails will come from the IPM office or Course Leader and directly relate to the course, i.e. Zoom invites.