UK APPLICATION FOR REGISTRATION

---

Your title

Mr Mrs Miss Ms Mstr Dr Prof Sir

Your first name

Your surname / family name

Previous name (if applicable)

Date of Birth

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Nationality

---

Grade you are applying to register as

Ambulance Care Assistant Ambulance Technician Assistant Practitioner Associate Ambulance Practitioner Blue Light Driving Instructor Combat Medical Technician L1 Combat Medical Technician L2 Combat Medical Technician L3 COVID-19 Volunteer Domiciliary Care Worker Emergency Care Assistant Fire Medical Responder First Aider First Responder Health Care Assistant Paramedic Phlebotomist Physician Associate Police Medic Student Paramedic

Have you ever applied to register with the HPAC or been registered?

No Yes

What was your registration number?

---

HOME CONTACT DETAILS

Address Line 1 (Street)

Address Line 2 (Town)

County

Postcode

Telephone / Mobile number

---

Email Address

Confirm Email Address

Set Password

Confirm password

Set a password for telephone contact

Next