Printable Enrolment Form - Tutorial

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:


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 £1200.00 to my card now and charge the balance fourteen days before the course start date, or
	Charge the initial fee of £1200.00 to my card now and charge the balance by 3, 6 or 8 instalments payable monthly during the course
or:
	I enclose a cheque or draft for the course fee in full payment
	I enclose a cheque of £1200.00 as a deposit and will pay the balance not less than fourteen days before the course start date
	I enclose a cheque or draft for £1200.00 and wish to pay the balance by instalments over the period of my course. (The balance is due by 3 or 6 instalments, payable monthly.)
Monthly instalments payable are:	3 month course £585.00, 6 month course £340.00, 9 month course £270.00

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: