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Course Programme /s

Venue:

Date:

Cost:

Registration

Name:_______________________________________________________

Address:_____________________________________________________

_____________________________________________________

Postcode:____________________________

Phone—work: ________________________

Phone—home:________________________

Mobile :_______________________________

Fax:_________________________________

Email:___________________________________________________

Form of Payment – please circle & complete

Cheque______________ enclosed. Payments to be made to Frank Furness

Invoice me; (full payment due 21 days prior to course)

Credit or debit card: (circle one) VISA MasterCard (post or fax back)

Card number________________________________________________________

Expiration date______________________________________________________

Print name as it appears on the card____________________________________

Fax to +44 (0)1923 254105 0r post to: Koutaki House, 1a Meadowbank, Watford WD19 4NP , United Kingdom