Evening courses enrolment form

Evening Course Enrolment Form

Please complete the details on this form, type direct into the boxes, and print it using the print command on your browser. Fax or post to address above.

Please choose the course you wish to take:

Travel Writing	Commencing 19 May 2008	£245.00
Introduction to Journalism	Commencing 24 September 2008	£365.00
Go Freelance!	Commencing 24 September 2008	£325.00
Creative Writing	Commencing 2 October 2008	£295.00

Name and details of Student:
Family Name:
First Name:
Title:	Other title:
Date of Birth:
Occupation:
Address detail

County/State:
Postal/Zip Code:
Country:
Email Address:
Telephone No:
Please help us by supplying the following information:
Purpose of taking this course:

Have you had work published previously?

How did you hear about the school?

Please enrol me on the above course in accordance with the LSJ standard terms and conditions. Payment of fees will be made as follows:
	I enclose a cheque or draft for the course fee in full payment
	I enclose a cheque of Ł100.00 as a deposit and will pay the balance not less than fourteen days before the course start date
	Please charge my credit card with full payment now.
	Charge the deposit of Ł100.00 to my card now and charge the balance fourteen days before the course start date.
Card type:
Card number:
Expiry date (month/year):	/
Security code (last three digits printed on signature strip):
If the cardholder is not the student, please give full name and address of the cardholder as shown on the relevant credit card statement:

Signed:

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