Employed Acupuncturist registration form

MAINAPPLICATION
1. Please complete this form if you would like to register named acupuncturists employed at a registered premises.
  
  You will require a passport style photograph of each employee to upload when completing this registration form. You will not be able to submit the registration without a photograph being uploaded.
  
  Please note: we only deal with business registrations within the Preston area. If you live outside this area or are not sure which council to register with please visit GOV.UK - Find your local council.
  
  For more information please visit tattooist, piercing and electrolysis registration.
  This form is one page long and should take approximately 5 minutes to complete.
2. Your details
  1. Full name
  2. Date of birth
  3. Telephone number
  4. Email address
3. Registered premises details
  1. Please provide the details of the registered premises at which the acupuncturists are employed.
  2. Business name
  3. Business address line 1
  4. Business address line 2 (optional)
  5. Town/city
  6. Postcode
4. How many acupuncturists do you wish to register? (Maximum of five per application form)
  
  1
  
  2
  
  3
  
  4
  
  5
5. Acupuncturist One
  1. Details
    
    Full name (optional)
    
    Date of birth (optional)
    
    Email address (optional)
  2. Convictions
    
    Has the above named acupuncturist been convicted of any offences relating to skin piercing activities under Section 16 of the Local Government Miscellaneous Provisions Act 1982? (optional)
    
    Yes
    
    No
    
    Please provide details of their conviction below: (optional)
    
    Did the convicting Magistrate cancel their Skin Piercing Registration as a result of the conviction? (optional)
    
    Yes
    
    No
  3. Photograph Upload
    
    Please upload a passport style photo of the above named acupuncturist. This will be included on your registration document. (optional)
    (Please ensure the document file size is less than 10MB)
6. Acupuncturist two
  1. Details
    
    Full name (optional)
    
    Date of birth (optional)
    
    Email address (optional)
  2. Convictions
    
    Has the above named acupuncturist been convicted of any offences relating to skin piercing activities under Section 16 of the Local Government Miscellaneous Provisions Act 1982? (optional)
    
    Yes
    
    No
    
    Please provide details of their conviction below: (optional)
    
    Did the convicting Magistrate cancel their Skin Piercing Registration as a result of the conviction? (optional)
    
    Yes
    
    No
  3. Photograph Upload
    
    Please upload a passport style photo of the above named acupuncturist. This will be included on your registration document. (optional)
    (Please ensure the document file size is less than 10MB)
7. Acupuncturist three
  1. Details
    
    Full name (optional)
    
    Date of birth (optional)
    
    Email address (optional)
  2. Convictions
    
    Has the above named acupuncturist been convicted of any offences relating to skin piercing activities under Section 16 of the Local Government Miscellaneous Provisions Act 1982? (optional)
    
    Yes
    
    No
    
    Please provide details of their conviction below: (optional)
    
    Did the convicting Magistrate cancel their Skin Piercing Registration as a result of the conviction? (optional)
    
    Yes
    
    No
  3. Photograph Upload
    
    Please upload a passport style photo of the above named acupuncturist. This will be included on your registration document. (optional)
    (Please ensure the document file size is less than 10MB)
8. Acupuncturist four
  1. Details
    
    Full name (optional)
    
    Date of birth (optional)
    
    Email address (optional)
  2. Convictions
    
    Has the above named acupuncturist been convicted of any offences relating to skin piercing activities under Section 16 of the Local Government Miscellaneous Provisions Act 1982? (optional)
    
    Yes
    
    No
    
    Please provide details of their conviction below: (optional)
    
    Did the convicting Magistrate cancel their Skin Piercing Registration as a result of the conviction? (optional)
    
    Yes
    
    No
  3. Photograph Upload
    
    Please upload a passport style photo of the above named acupuncturist. This will be included on your registration document. (optional)
    (Please ensure the document file size is less than 10MB)
9. Acupuncturist five
  1. Details
    
    Full name (optional)
    
    Date of birth (optional)
    
    Email address (optional)
  2. Convictions
    
    Has the above named acupuncturist been convicted of any offences relating to skin piercing activities under Section 16 of the Local Government Miscellaneous Provisions Act 1982? (optional)
    
    Yes
    
    No
    
    Please provide details of their conviction below: (optional)
    
    Did the convicting Magistrate cancel their Skin Piercing Registration as a result of the conviction? (optional)
    
    Yes
    
    No
  3. Photograph Upload
    
    Please upload a passport style photo of the above named acupuncturist. This will be included on your registration document. (optional)
    (Please ensure the document file size is less than 10MB)
10. Amount payable
13. Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).
  
  Any disclosures or sharing of information will only take place where required or permitted by law. For further information please see our privacy notice .

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Employed Acupuncturist registration form