Clear Intentions Course Booking Form

1. Contact details:
Full Name:	Name is required.
Address:	Address is required.
Telephone/Mobile:	Telephone Number is required.
Email:	Email Address is required.Invalid format.
Date of Birth:	Date of Birth is required dd/mm/yyyy.Invalid format - dd/mm/yyyy required.
Do you have any disabilities or conditions which may require any special help during the course/workshop:
How did you hear about the course/workshop:

2. Declaration:
Confirmation is required. I confirm that I have read and understood and am happy to accept the Booking Terms and Conditions (available by clicking here). Please note that a payment made via PayPal or Credit/Debit Card also forms acceptance of the Booking Terms and Conditions.
Signed:	Name/signature is required.
Print name:	Printed name is required.
Date:	Todays date is required dd/mm/yyyy.Invalid format - dd/mm/yyyy required.

3. Method of payment:
Credit/Debit Card (all major cards accepted) PayPal

Please state amount due: £ Deposit Full amount (required for all individual courses/workshops) To secure your place on a Programme: A deposit of £100.00 secures a place. The balance is then due no later than 30 days prior to commencement of the course. You can choose to spread the cost of the programme and pay by affordable monthly installments over the duration of your course and on an INTEREST FREE BASIS - click here to complete an Easy Payment Plan form and submit it with your booking.