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McMURRAY TRAINING INSTITUTE

By Dan Matthews,2014-09-25 21:11
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McMURRAY TRAINING INSTITUTEMcMU

    ALBERTA MASSAGE TRAINING

    # 211 - 11402-100 St.

    Grande Prairie, AB,

    T8V 2N5

    Phone 780-402-7735 / FAX 780-513-1362

    Toll Free: 1-877-768-8400

    E-mail: principal@albertamassagetraining.com

    APPLICATION FOR ADMISSION

    This application is no way obligates the applicant or the Alberta Massage Training. Location interested in (please choose one)

     Grande Prairie Fort McMurray Edmonton Lloydminster Calgary

     PROGRAM ; Swedish Relaxation Massage ; Massage Therapy

    NAME and ADDRESS (Please Print Clearly)

    DATE: _________________________________________________________________

    NAME: _________________________________________________________________

    MAILING ADDRESS: (permanent address, where all correspondence will be mailed). Please notify the A.M.T. of any changes.

    Mailing Address: _________________________________________________________

    Town/City: ______________________________________________________________

    Province:____________________________ Postal Code:________________________

    Email: ____________________ Home Phone:____________ Work:____________

    SOCIAL INSURANCE NUMBER: __________________________________________

PERSON TO NOTIFY IN CASE OF EMERGENCY

    Full Name: ______________________________________ Phone # ________________

    Mailing Address: _________________________________________________________

    Town/City:_______________ Province:____________ Postal Code:_______ Relationship to you:_______________________________________________________

PERSONAL DATA

    Birth Date: Year:_____________________ Month:__________________ Day:________

Do you have any medical condition that we should be aware of?

    ; No ; Yes specify

    ______________________________________________________________________

    Where did you hear about us?_______________________________________________

PREVIOUS EDUCATION

    Last high school attended: _________________________________________________________

    Town/City______________________________________________________________________

    Province________________________________________________________________________

    Your Name While Attending _______________________________________________________

    Date attended from: Month ______ Year_______ To: Month__________ Year ____________

    Last grade level you have achieved or Diploma ________________________________________

Post Secondary Education ; Yes ; No

    Credential; _____________________________________________________________________

EMPLOYMENT

Are you now employed; ___________

     Name and Address of Employer _______________________________________

     Position:__________________ Full/Part-time:________________________

     Start Date: ____________________ Duties: _____________________________

CAREER PLANNING

    In your own words describe your career goals. (add additional sheets if necessary) ______________________________________________________________________________________

    ______________________________________________________________________________________

    ______________________________________________________________________________________

    ______________________________________________________________________________________

REFERENCES

    Name: ______________________ Relationship: _________________ Phone: ____________________ Email address: ____________________________________________________

    Name: ______________________ Relationship: __________________ Phone: ____________________ Email address: ____________________________________________________

PROGRAM INFORMATION

    Do you need more information about the Alberta Massage Training at this time?

; Yes ; No

Specify what you need to know

    ______________________________________________________________________________________

    ______________________________________________________________________________________

    ______________________________________________________________________________________

    ______________________________________________________________________________________

    ______________________________________________________________________________________

DECLARATION

    I certify that the information given is correct and complete. I understand that falsifying documents or information on this application will result in permanent dismissal from the Alberta Massage Training. I agree that all documents required for admission become the property of the Alberta Massage Training and that they will not be returning to me. If admitted, I agree to comply with all rules and regulations of the Alberta Massage Training.

Date: _______________________ Signature:___________________________

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