Printable Application for Enrolment, Course Registration & Assessment for Postal Courses

For which course are you applying? please circle or highlight one of the following Preliminary Certificate     Certificate of Ed. Studies      Certificate in Phonetics     Certificate in Theory & Methodology of TESOL Advanced Certificate in TESOL     Diploma in TESOL      Advanced Diploma     Fellow of the College of Teachers
I would like to start in:	____________ month
Title	__________
First name(s)	____________________________________
Family name	____________________________________
Telephone	____________________________________
E-mail	____________________________________
Address, line 1	________________________________________________
Address, line 2	________________________________________________
Town/City	____________________________________
County/State	________________________
Country	________________________  Post/Zip code ____________
Mother tongue	________________________
Nationality	________________________  Date of birth ____________
Occupation	____________________________________
Highest qualification	____________________________________
Awarding body & date	________________________________________________
How did you find our website?	____________________________________
Payment method	Credit/debit card      Bank transfer      Cheque
Do you wish to pay in full, taking advantage of the 10% discount, or pay by interest free instalments? In full    By instalments    please circle or highlight one    (Payment in full or initial payment is due when enrolling.) If paying by instalments you will receive an invoice with amounts and dates due for subsequent payments in your first postal pack.
For payment by Credit or Debit card please complete the section below. For payment by other methods, leave the next section blank. If you would rather provide your credit card details via telephone, please call on 0114 2621522 weekdays 9am-5pm. Any special offers currently available will be automatically deducted from the payment in full fee listed. Please contact us with any queries you may have.
Enter any offer/promotional code:	____________
Name & initial (as on card)	________________________________________________
Card type	MasterCard    Visa    Visa Electron    Switch/Maestro    Solo   please circle
Start Date (if on card)	___________   Expiry Date ___________ CV2 number _____
Card number	______________________________   Issue no. (if on card) ___
Total amount	__________ see fees page for correct amount
In submitting this form I confirm that to the best of my knowledge the information given on this form is true and correct. I have read and understood the conditions set out under Conditions and Refunds and agree to abide by them.
Signature	________________________     Date ____________