Mylocum
Full Name: *
Email Address: *
Phone Number: *
Speciality: *
What training do you want to do? * Select Training Basic Life Support Fire Safety Awareness Moving and Handling All three
Are you registered with Mylocum? * Select Option Yes No
Which region do you work in across the UK? * Select Region London Wales Scotland Yorkshire and Humber Eastern/Anglia West Midlands East Midlands South East South West North East North West
As part of our referral program, we're providing FREE certificates if you bring a friend who works as a nurse in the NHS. Both you and your friend will receive a free certificate upon completing the free training.
Do you want to bring a Friend? * YesNo
Friend's Full Name: *
Friend's Speciality: *
Friend's Email Address: *
Friend's Phone Number: *
Friend's NMC Pin Number:
Friend's Region: * Select Region London Wales Scotland Yorkshire and Humber Eastern/Anglia West Midlands East Midlands South East South West North East North West
By filling up this form you agree to our Terms & Conditions and for us to contact you in regards to your application