Lumina Learning | Affiliate Application

New Practitioner Application Form

To apply for a Lumina Learning Practitioner account please complete the form below.

Fields marked with a * are required for registration.

Your Home Region

* Please select your home region

Reference Code (if applicable)

Personal Information

* First Name

* Last Name

* Primary Contact Number Country Code

* Primary Contact Number

Mobile Number Country Code

Secondary Contact Number

Business Address

* Address Line 1

Address Line 2

Address Line 3

* Town

* County

* Postcode

* Country

Tax Details

* Business Legal Name

Business Legal Number

* Country

Tax Registration Number

Billing Address

Use the business address above for billing

* Address Line 1

Address Line 2

Address Line 3

* Town

* County

* Postcode

* Country

Locale Information

* Language

* Time Zone

Account Password

Please enter a password below, this will be used to setup your initial account. You will be notified by a Lumina Learning Partner when your account becomes active.

* Email Address

* Password

* Confirm Password

Business Agreement

Please tick the box below to indicate that you have read and agree to the following:

I agree

Personal Information and Privacy

By enrolling to become a Practitioner you share some of your personal information with:

Lumina Learning - More Details
- More Details

The personal information you share as a Practitioner is processed in accordance with the Practitioner Privacy Notice.

Please indicate that you acknowledge the following:

Practitioner Privacy Notice

I acknowledge