Benesh Movement Notation for Ballet Distance Learning Course Application form

Please enrol me on BMN4Ballet distance learning course:

Unit 1 / X / Unit 2 / Unit 3 / or / Unit 4
First Name / Surname
RAD Membership No.
(if applicable)
Mailing Address
Postcode/Zip code
Province/County/State / Country
Telephone / home / work / mobile
Email (please print clearly)
Pay by / Credit/Debit Card / Bank Transfer (See details on page 2)
Name on Card: / Amount:
Card Number
Start Date: / Expiry Date: / Security Code:

[The Card Security Code for AMEX is a four digit number that can be found on the front of the card above the embossed card number; for all other cards it is a three digit number which can be found on the back of the signature strip. The Card Security Code will be blacked out/made illegible once the transaction has been processed.]

Please indicate if you would like to receive a receipt

I agree to abide by the Academy’s general terms and conditions:

If you are sending your application form by email, please select this box and type your name as a substitute for your signature.

Signature: / Date:

THE COMPLETED APPLICATION FORM AND PAYMENT SHOULD BE RETURNED TO
The Benesh Institute, Royal Academy of Dance, 36 Battersea Square, London SW11 3RA .

For official use / Received / Recorded / Confirmed / Tutor
Finance / Code / 23 / - / CBMN - / 1300 / - / 2022 / E

UPDATED 22.01.2016

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If you wish to pay by bank transfer, please follow the guidelines below:

All charges must be borne by the transferrer. When submitting your application, please attach a copy of the bank transfer confirmation to help us to match up the payments. Please ensure that your name (not the name of the transferrerif different from yours), membership number and name of the course (BMN4Ballet) is given to the bank to ensure we can identify the payment. Failure to do so can result in your payment remaining unidentified and your fees considered being outstanding.

Bank details

  • Bank: HSBC Bank PLC
  • Branch: 31 Holborn Circus, London, EC1N 2HR
  • Account Name: Royal Academy of Dance

For sterling transfers

  • Bank Account No: 81783521
  • Sort Code: 40-03-28
  • Swift Code: MIDLGB22
  • IBAN: GB91MIDL40032881783521

General Terms & Conditions

General Terms and Conditions

1. All applications and payments will be processed in order of receipt.

2. We will contact you primarily by email. If the email address on the application form is unclear, incorrect or illegible, the RAD incorporating the Benesh Institute cannot be held responsible for missed or misdirected email communications.

3. Applications are non-transferable.

4. The Academy does not normally provide receipts unless requested to do so. An alternative for teachers is to retain a copy of their application and match it with their credit card slip / bank statement as evidence for their accountants.

5. The Academy reserves the right to alter the advertised programme and/or tutor without prior notice. The information in this and other printed or electronic brochures/notices is correct at the time of print or going online.

6. The RAD reserves the right to amend the Application Form and these Terms and Conditions.

7. Any CPD Value that an activity may carry is awarded in accordance with the Rules and Regulations of the RAD CPD Scheme. Any CPD Value accrued cannot be transferred between applicants.

Data Protection Statement

The Royal Academy of Dance Group of companies provides dance training, dance notation, dance teacher education and dance assessment services to a range of customers. It holds contact details to enable it to provide customers and members with information on membership, programmes of study and courses, conferences, events and activities, and related products and resources that might be of interest. In providing us with your contact details you give us permission to contact you in relation to the business of the Academy, and we will not disclose your information to any third parties except where legally required to do so. If you do not wish to receive any information about or from the Royal Academy of Dance please tick here □

We may, from time to time, contact you individually about other carefully selected third party services which we think may be of interest to you. If you wish to receive information from the Royal Academy of Dance about carefully selected third party services please tick here □

The Royal Academy of Dance is a charity registered in England and Wales No 312826

Thank you for your application for Benesh Movement Notation for Ballet Distance Learning Course. We are delighted that you want to learn Benesh notation, and would like to know a little bit about you in order to ensure that course materials and tutoring are as closely matched as possible to the needs and interests of our students.

If you are enrolling on Unit 1 please state briefly below:

How you heard about Benesh Movement Notation
How you heard about BMN for Ballet distance learning course
Your dance background and experience
Why you would like to learn BMN (present needs, future plans etc)
Anything else you would like to tell us
NAME: / DATE:

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