Printable Enrolment Form - Evening

Please complete the details on this Form, print it using your browser print command, and fax or post to the address below:

THE LONDON SCHOOL OF JOURNALISM
126 SHIRLAND ROAD
LONDON
W9 2BT
ENGLAND
FAX: (+44) 207 432 8141

Please select the course for which you would like to register:

22 September 2010:	£365.00	Journalism Evening Class
6 October 2010:	£325.00	Go Freelance Evening Class
7 October 2010:	£325.00	Creative Writing Evening Class
8 November 2010:	£295.00	Travel Writing Evening Class


Please complete the following details:
Title:
First name:
Last name:
Company:
Occupation:
Date of Birth:
Address:
City:
State/Province/Region:
Country:
Postcode:
Telephone:
Email:

Please enrol me on the above course in accordance with the LSJ standard terms and conditions. Payment of fees will be made as follows:
	Please charge my credit card with full payment now, or
	Charge the deposit of £100.00 to my card now and charge the balance fourteen days before the course start date
or:
	I enclose a cheque for the course fee in full payment, or
	I enclose a cheque of £100.00 as a deposit and will pay the balance not less than fourteen days before the course start date

Credit card type:
Card Number:
3 Digit Security Code:	(This is printed on the back of your credit card)
Expiry Date:	/ (mm/yyyy)
Issue Date: (Switch)	/ (mm/yyyy) Number:
Your name exactly as shown on your credit card:

Address on credit card statement If different from delivery address:

Please also give your name and address if this is a corporate order:


Please help us by supplying the following information:
Purpose of taking this course:

Have you had work published previously?

How did you hear about the school?

Signed: