Section 1: Personal details
First name
*
Last name
*
Job title
*
Email
*
Telephone
Membership number
Employer
*
Address line 1
*
Address line 2
Postcode
*
Section 2 - Courses attended (required)
Please complete details of courses requires for the academic part of APEX
Name of course/qualification
Date attended:
What date did you complete your course/due to complete?
Please submit proof of qualifications
Section 3 - Payment details
Payment options:
Visa/Debit/Credit card
Invoice to employer
Contact name:
Invoice address:
Why have you decided to join the APEX online programme?
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Please tell us if you would like to stay informed about CIH membership:
*
Yes
No
Please tell us if you would like to stayed informed about CIH products and services:
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Yes
No