Teaching Screenwriting in Further Education - Registration Form

Teaching Screenwriting in Further Education - Registration Form

2nd October 2010

Please return this form to

Laura Hampshaw, CEMP, The Media School, Bournemouth University, Fern Barrow,Poole, Dorset, BH12 5BB

DELEGATE INFORMATION (please use the TAB key to move between the fields to insert data)
Title / Mr Mrs Miss Ms Other
First Name(s)
Surname
Correspondence Address
Tel No
E-mail
Please indicate any special access or dietary requirement(s)
COURSE DATE & BOOKING RATES
Course Date(s) / 2nd October 2010
Course Fees / £120 (standard) / £60 (NAWE subsidised)
(We reserve the right to request further information in order to verify this information)
PAYMENT METHOD
Cheque: payable to Bournemouth University.
Credit / Debit Card: please can you provide the following information which we will validate in order to ensure that your card is not being used fraudulently. This information will be made inaccessible as soon as the transaction has been processed.
Mastercard Visa Switch Visa Debit or Electron
Name of Cardholder / Amount to be Taken / £
Card Number
Start Date
(MM/YY) / Expiry Date
(MM/YY) / Issue Number
(Switch Only)
Contact Number* / Date
(DD/MM/YY) / Date to be Taken
(DD/MM/YY)
Signature

Data Protection Act Statement: Under the Data Protection Act (1998), we have a legal duty to protect any information we collect from you.Any information which you provide to us by filling in this form will be processed in accordance with the Data Protection Act (1998) we will not use this information for any other purpose than the organisation management of this course. I have read understand the above statement:

Signature:Date:

Additional Terms and Conditions:

All cancellations must be received in writing. Cancellations less than 21 days before the start of the course will not beeligible for a refund.

A substitute delegate can be named at any time before the start of the course without charge.

Thebookingfee has to bereceived at least 48 hours before the start of the course, failing which delegatesmay be refused admission.Your booking is not considered confirmed until payment is received in full. Should you wish to pay the booking fee by credit/debit card, you hereby authorise us to collect the payment at the time of booking from the credit/debit card details supplied above.

This booking form constitutes a legally binding contract. It may be necessary for reasons beyond our control to change the content timing of the course, the trainers, the date or the venue. In the unlikely event of the course being cancelled, we will automaticallymake a full refund but disclaim any further liability.

* Your contract telephone number may be required in the event that we need to verify your credit/debit card details