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SUMMER SCHOOL REGISTRATION FORM

COMPLETE IN FULL. Use ONE form per person registering.


Please print and tick all relevant boxes –incomplete forms will not be processed.
Surname: Student No. (If known):
Prof/Dr/Mr/Mrs/Miss/Ms: First Name/Initials:

Please tick if entitled to a REDUCED FEE and complete section D overleaf.


Member of Staff/Spouse Student Other reason

I WISH TO REGISTER FOR THE FOLLOWING COURSE(S):


Course No Course Title Fee

ENCLOSE MY PAYMENT FOR TOTAL:


(Please complete Section A overleaf)

CONTACT DETAILS
To be completed in full by all OFFICE USE ONLY

Address............................................................................................................................
........................................................................................................................................ Q C Q C Q C
........................................................................................................................................
........................................................................................................................................ K E K E K E
........................................................................................................................................ Entry dates
..................................................................... Postal Code: ...................................... Initials
Telephone(h)................................................ (w) ..................................................... Handouts
Fax................................................................................................................................... T P Date
Electronic Mail .................................................................................................................

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