Coach Training Registration Form

Full Name *

First

Last

Email Address *

Email

Confirm Email

Contact Phone Number *

DOB *

Date of Birth

I am over 18 years old *

Yes
No

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Occupation *

Do you have any psychological issues which we need to know about? *

Yes
No

If yes, please list any diagnosed medical issues

Have you received any coaching training before? *

Yes
No

If yes, please detail the training, dates and qualifications

How did you hear about us *

What will coaching give you personally/professionally? *

I give permission for photos to be taken for marketing purposes *

Yes
No

Disclaimer

To the fullest extent permitted by applicable law, neither NoorWorks Ltd nor any of its directors, employees, affiliates or other representatives will be liable for any loss or damage arising out of or in connection with your use of, or your inability to use, the materials, information, and/or facilities or services offered including, but not limited to, indirect or consequential loss, however arising, and claims of third parties.

I agree to the terms and conditions *

Yes
No

Payment Information

Please transfer the relevant payment to the following account using your name as the reference. If you would like to arrange a payment plan, email us on info@noorworks.com

Name : Royal Bank of Scotland
Account Name : NoorWorks Ltd
Account Number : 10111955
Sort-Code : 83-04-25

Has payment been made? *

Yes
No

Gift Space

As part of our desire to give back and support people in our world we would like to offer a gift space to someone deserving. Please provide the details of a person who you feel should be given a space on our Coaching programme. We will select a person when registrations end and inform them of their place on the programme.

Nominee Contact Name

First

Last

Nominee Occupation

Nominee Email Address

This person deserves a place on this course because …..