P.O. Box 695                  Phone/Fax:  (03) 5427 0880  
Gisborne                      Email:   admin@homstudy.net   
Victoria. 3437   

  HOMOEOPATHIC APPLICATION / ENROLMENT FORM
(Please PRINT or TYPE)

NAME:   Dr.   Mr.   Mrs.   Miss.  Ms. …………………………………………………

ADDRESS:   ………………………….....................…………………………………. 

                     ..................................................................................  Area Code: ………

TELEPHONE:  Home:   (    ) ……………………Email: ............ ………………………   

ACADEMIC ACHIEVEMENTS:  ………………………………………….…………..     

........................................................................................................................................

HOMOEOPATHIC COURSE STATUS: (please circle either A or B below)

A. I have completed the required Health Science units (please enclose documents)

B. I have not completed the required Health Science units

Please find enclosed the following requirements:

1. ACHH commencement fees ($250 + book fees to $173 if required).

2. Two passport size photographs.

•  Photocopies of qualifications if RPL exemptions are requested.

Cheque/Money Order made to: Australasian College of Hahnemannian Homoeopathy.

Post to: The Co-ordinator

P.O. Box 695                  
Gisborne                    
Victoria. 3437 

.......................................................... Date: ..........................

Signature of Applicant/Enrolee

I would like my name to be included on the list of students in my State to participate in study groups. Yes [ ] No [ ]

 Email A.C.H.H. Link To Home Page

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