Please complete a separate form for each course you wish to attend.
Personal Details
TITLE
Mr
Mrs
Miss
Ms
FIRST NAME
SURNAME
ADDRESS
TOWN
POSTCODE
TELEPHONE
MOBILE
EMAIL
Do you have any special requirements?
Employment details (If applicable)
Course Details
Four day Instructor Course
Date - please select
20 / 21 / 22 / 23 March 2012 (Aldersley High School, Wolverhampton, WV8 1RT)
Assistant Instructor Course
Date - please select
Instructor Trainer Training Course
Date - please select
Special Educational Needs
Date - please select
First Aid
Date - please select
Off Road Training
Date - please select
Cycle Maintenance Level 1
Date - please select
Cycle Maintenance Level 2
Date - please select
Costs
Once we receive your provisional booking request we will contact you regarding costs and the availability of any bursaries/funding. At this time we will also discuss deposits and how to pay. Until such time your booking is not confirmed. Once payment is secured full confirmation will be sent.
Purchase Order Number (If applicable)
I HAVE READ AND UNDERSTAND THE
BOOKING CONDITIONS
- Tick box
