Bpm Active Training Courses Booking Form

bpm active Training Courses Booking Form

bpm active Training Studio, Unit 26, BSS House, Cheney Manor, Swindon, Wilts SN2 2PJ

Please complete the following form in BLOCK CAPITALS

PERSONAL DETAILS

First Name: / Mobile Number:
Surname: / Home Number:
Address: / Work Number:
Email:
Emergency Contact Name:
Emergency Contact Number:
Post Code: / How did you hear about bpm active:
Date of Birth:
Male/Female: / Occupation:

COURSE DETAILS

Course / Start Date / Venue / Price

Total

RELEVANT QUALIFICATIONS

Please specify any previous training or qualifications relevant for the course you wish to book upon. A photocopy of certificates (e.g. Exercise and Fitness Knowledge) must also be submitted with this application for APA (Approved Prior Achievement) approval.

Examining Body / Level / Subject / Grade / Date awarded

INDIVIDUAL NEEDS

This information is treated as confidential and will only be used to help you.

Do you have any of the following? (Please tick )

A learning difficulty / Dyslexia / Visual or hearing impairment / English as second language
Please give additional details of any conditions which would require extra learning support:

If you have answered yes to any of the above and would like to discuss your individual learning needs further, please contact bpm active in confidence on 0773 242 7882

PAYMENT METHODS

• Credit/Debit Card (please call bpm active on 0773 242 7882)
• Cheque (please make cheques payable to bpm active and send along with this booking form to bpm active, PO Box 3130, Swindon, Wiltshire, SN2 9BQ)
• Cash (in person only. Do not send cash through the post)
• Request invoice
• Standing Order (contact bpm active for account information)
• Easy pay options (contact bpm active for payment options to suit your needs)

CONFIRMATION

Signed:______Date:______

Signature of parent/guardian (if you are under 18)______

Thank you for choosing to study with bpm active and we look forward to meeting you on the course!