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Please complete
in BLOCK capitals
Course dates you
would like to attend: _______________________
Applicant Details
Title:___________________
First Name: __________________________________________________
Last Name: __________________________________________________
Nationality:______________
Date of Birth:____________
Home (Permanent)
Address: _________________________________
_________________________________________________________
Contact Address:__________________________________________
_________________________________________________________
Home Telephone Number:
(day): _______________________
(evening): ___________________
Fax: ___________________________
email: ___________________
Contact Telephone
Number:
(day): _______________________
(evening): ___________________
Fax: ___________________________
email: ___________________
Language Ability,
TOEFL/IELTS score (if known):________________
Would you like us
to assist with your accomodation requirements? (Yes/No)
_______________
Marketing Information
How did you hear
about this course?
Newspaper/magazine:
Brochure:
Internet:
Friends:
Would you like to
be added to our mailing list? This information will not be forwarded
to third parties. (Yes/No) ___________
Current Knowledge
or Skills
How would you describe
your current Design and Media knowledge?
No prior knowledge:
Some Familiarity:
Good understanding:
Please use this
space to describe what it is that you would like to achieve on your
programme and in your time in London. You may continue on a separate
sheet if necessary.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Terms & Conditions
Non attendance due
to illness, or for personal or professional reasons, forfeits the right
to refunds, extra tuition or transferral. Cancellations by participants,
for whatever reason, 28 days or more prior to the course commencing,
are subject to a £50 handling charge. Cancellations by participants,
for whatever reason, less than 28 working days prior to the course commencing
will not be eligible for a refund. DALI Ltd reserves the right to cancel
a course should it be necessary, in which eventuality a full refund
will be made to the payee. DALI Ltd reserves the right to substitute
course tutors for whatever reason.
I confirm I have
read the course information in the current brochure or web-site, and
that I have read and accept the Terms and Conditions stated.
Signature:________________________________Date:______________
Payment Details
1:
Please debit my credit card: VISA:
MASTERCARD:
SWITCH:
Card Number:__________________________________
Valid date:_______________Expiry
Date:______________
Name on card:_________________________________
Card issue number
(Switch only):__________________
Signature of card
holder:_________________________
2:
I have enclosed a cheque for £___________ made payable to Development
at London Institute Ltd.
3:
I have enclosed a copy of the BACS transfer.
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