Booking Form
Course Title  
Course Start Date Day    Year 
Booking more than one place?  You will be given the option to book another once you have submitted this form  I am booking 1 place only      more than 1
Title Mr    Mrs     Miss   Ms   Other
 
Learner's Surname  
Organisation Name
Organisation Address  
Organisation Postcode
Your role in Organisation  
Your Email Address
Your Telephone no
Learner's Mobile no *

Do you have a disability or learning difficulty we need to be aware of in order to meet your needs ?  

   Yes   No
If yes; please give details about your needs and how we can support you on the course:
What is your main reason for attending the course?  
What outcomes would you like to achieve and are there any elements of this course that are particularly important to you?  
What is your present level of knowledge about the course topic?  
Organisation Status Charity or community group
Business or private
Public / statutory org
What is your organisations main area of work?

 

How would you like to pay?

 Please make one payment in full for the total cost of the course.

You must have provided the full name and address of the Organisation if an invoice is required, in addition to the details requested here:

 

Please let us know if your organisation will need to raise a Purchase Order for the invoice. Enter either the PO number, or indicate whether PO will follow or is not required

 

 

PayPal     

Invoice required

Name to be invoiced   

Email address to be invoiced 

Purchase Order Info

 

Is there any other information we need to assist your learning?
How did you hear about the course?  
Are you happy with our terms and conditions?  Yes   No    
Would you be happy to participate in future surveys?  Yes   No
Would you be happy to receive email information about future courses we run?  Yes   No
                     
   

Please note that course places will only be provisionally booked for 10 working days until the course fee is received.

Data Protection: Community Action Fareham is committed to safeguarding people's personal data.  Information given in this form will be used for training administration only, unless either the marketing and survey boxes are ticked - in which case these details will only be used by Community Action Fareham to keep you up to date about courses we run and ask you about our services for future development