SPC BOOKING FORM
PLEASE COMPLETE ALL SECTIONS USING BLOCK CAPITALS
MR/MRS/MISS/MS / FIRST NAME: / SURNAME:ADDRESS:
POSTCODE:
TEL: / MOBILE:
EMAIL: / D.O.B:
CURRENT OCCUPATION:
1. Do you have any disabilities or special needs? Yes No
If yes please supply details: ......
2. Please supply details of any anatomy and physiology, personal training, nutrition or other sport, exercise, health-related qualifications: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
3. Please indicate the course/workshop title, proposed start date and cost:
Title: ………………………………………………………………………………………. Proposed Start Date: ……………………
Cost: ……………………
4. On receipt of this form we will invoice you for payment. Please indicate how you will pay for the course/workshop: Debit Card □ Credit Card □ Standing Order □ Bank Transfer □
External Source (SPC Ltd will invoice the named organisation below):
Name of employer/organisation: ……………………………………………………………………………………………………….
Address:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Contact Name: ……………………………………………………………………………………………………………………………………
Telephone No: …………………………………………………………………………………………………………………………………….
5. Amount Enclosed:
□ I am paying the full amount now of £______.
□ I enclose my deposit of £______and the balance I will pay prior to the start of the course/workshop.
□ I am paying in monthly instalments of £______on agreement with the Managing Director (excluding NASM courses).
6. How did you hear about the course/workshop?
…………………………………………………………………………………………………………………………………………………………….
7. DECLARATION
I confirm the information I have given in this form is correct and complete to the best of my knowledge. I confirm that I have read and understood the Terms and Conditions.
Data Protection:
I consent to Sports Performance Consultancy (SPC) Ltd processing the personal information set out in this form and other data which Sports Performance Consultancy (SPC) Ltd may obtain from me (or from other people about me) for the purposes stated in this form or connected with my studies or any other legitimate reason.
Signed: ...... Date: ......
Please e-mail this form along with a recent photo to:
Confirmation of your booking will be forwarded to you as soon as payment has been received.