COURSE BOOKING FORM - ITALY
IMPERIAL CLASSICAL BALLET FACULTY
DATE / COURSE / TIMESaturday 24th January 2015 / Imperial Classical Ballet Working with the New CDs for Grade Examinations / 10:00 – 17:00
CATEGORY / FEE / PLEASE TICK
FULL TEACHING MEMBER (up-to-date for 2015): / 80 EUROS
PROVISIONAL MEMBER (up-to-date for 2015): / 65 EUROS
NON-MEMBER / 95 EUROS
Those teachers who have renewed their membership for 2015 can attend by paying the 'non-member' fee
Participants are recommended to purchase the new Imperial Classical Ballet CDs prior to the course; they can be ordered from our online shop: from
APPLICANT DETAILS
Title & Full Name: Click here to enter text.
Full Address & Postcode: Click here to enter text.
Tel No: Click here to enter text.Mobile No: Click here to enter text.
Email: Click here to enter text.PIN or ISTD Membership No: Click here to enter text.
Do you have any allergies, injuries or disabilities etc of which the ISTD should be made aware? Yes No
Details: Click here to enter text.
Do you have any mobility/access requirements? Yes No
Details: Click here to enter text.
EMERGENCY CONTACT DETAILS FOR NEXT OF KIN
Please provide the details of a person whom we may contact in the event of an emergency on the day:
Contact Name: Click here to enter text.Contact No: Click here to enter text.
PAYMENT DETAILS
CREDIT/DEBIT CARD: The Grand Total due will be converted into Pounds Sterling in order for the funds to be taken from your card. We shall use the following website to calculate the amount due:
All major credit cards are accepted except American Express.
Amount: Click here to enter text.Cardholder Name: Click here to enter text.
16-Digit Card Number: Click here to enter text.
Card type: Visa MasterCard Maestro Issue No (Maestro): Click here to enter text.
3-Digit Card Security Number: Click here to enter text.
Start Date (MM/YY): Click here to enter text. Expiry Date (MM/YY): Click here to enter text.
BANK TRANSFER: Please reference your payment clearly with ‘E&T ITALY’ and your name.
Don’t forget to include a copy of the bank transfer with your submission/application
Bank: National Westminster Bank
Branch: Finsbury Square Branch
Address: PO Box 549, 78 Finsbury Pavement, LONDON EC2A 1JA, UK
Sort Code: 60-08-23
Account Number: 64000834
Account Name: ISTD
IBAN BIC: NWBK GB 2L
IBAN: GB 34 NWBK 6072 1464 0008 34
BOOKING CONDITIONS
- All fees must be paid in full with cleared funds at least 7 days before a course begins.
- Payment on the day of the course is not acceptable.
- Bookings cancelled less than one month before the start of the course will not be refunded unless a medical certificate is provided or under exceptional circumstances. The ISTD also reserve the right to retain all or part of the course fee should the cancellation be made with more than one month’s notice.
- The ISTD will not refund any incurred costs (such as travel and accommodation) unless the event is cancelled by the ISTD less than three weeks before the start date of the event.
- The ISTD has the right to refuse applications on the grounds of health and safety or if acceptance would contravene its Regulatory Authority Approval.
- The ISTD will not be held responsible for any accident, damage, injury or loss, personal or otherwise, that may occur during the event. Delegates should therefore provide their own insurance if they wish to do so.
- All delegates must provide emergency contact details for the duration of their time at the event.
- Filming or photography of the event is not permitted without the expressed written permission of the ISTD.
I have read and will observe the booking conditions listed above:
Signature: Click here to enter text.Date:Click here to enter text.
PLEASE RETURN YOUR COMPLETED APPLICATION TO:
Education & Training Department, Imperial Society of Teachers of Dancing, Imperial House, 22/26 Paul Street, London EC2A 4QE
Email: * Tel: +44 (0)20 7377 1577 * Fax: +44 (0)20 7247 8309
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