|
Application Form for Training
SURNAME:............................................................
FORENAMES......................................................................
ADDRESS:.............................................................TOWN:...............................................................................
POSTCODE............................................................MOBILE NUMBER................................................................
HOME
TELEPHONE #:..............................................DAYTIME PHONE
#:............................................................
EMAIL
ADDRESS:…………………………………........................................................................…..……………….....
HAVE
YOU EVER BEEN CONVICTED OF ANY CRIMINAL
OFFENCE ........................................................................
(THIS QUESTION MUST BE ANSWERED DUE
TO THE NATURE OF THE TRAINING).
IF YES PLEASE GIVE
DETAILS: ......................................................................................................................
WHICH COURSE OPTION / OPTIONS ARE YOU
BOOKING: ..................................................................................
WHAT COURSE DATES ARE YOU BOOKING:
MONTH ……......................…..DATES ...............................................
A LIST OF LOCAL HOTELS ARE
AVAILABLE ON THIS WEB SITE.
PLEASE ENCLOSE A PASSPORT PHOTOGRAPH FOR YOUR PERSONAL ID
CARD IF REQUIRED.
A DEPOSIT OF £100.00 IS REQUIRED
WITH YOUR APPLICATION FORM TO SECURE YOUR COURSE PLACE. THE BALANCE IS DUE
ON THE FIRST DAY OF THE TRAINING COURSE EITHER IN CASH, VISA / MASTERCARD /
SWITCH / OR BANKERS CHEQUE.
PLEASE TELEPHONE 01933 679990 FOR
DETAILS OF NEXT AVAILABLE COURSE DATES or click the link for course dates.
IF PAYING DEPOSIT BY VISA /
MASTERCARD PLEASE COMPLETE THE FOLLOWING INFORMATION.
(Please do not email credit card
details for your own security).
ALL DEPOSITS TO BE SENT TO HEAD
OFFICE:
JUST LOCKS 16 COWPER ROAD, WELLINGBOROUGH,
NORTHAMPTONSHIRE, NN8 3NN.
PLEASE TICK ONE OF THE FOLLOWING
CARDS.
CARD TYPE
MASTERCARD.......................... VISA...........................DEBIT
CARD........................................
ACCOUNT
NUMBER .....................................................................
VALID FROM........................................
NAME & INITIALS AS THEY APPEAR ON
CARD............................................................................................
CARD ISSUE
NUMBER.................................................................. CARD EXPIRES END
DATE.......................
I DECLARE THAT THE INFORMATION ABOVE
IS CORRECT.
SIGNED.............................................................................……..
DATED:................……...........................
we accept the following cards:
If paying by credit card 2.5% will be added to invoice
total. Debit card & bank cheque f.o.c. |