Reflecting on Children,
Youth and Leisure

Wednesday 14th April 2010
10am-4pm

BOOKING FORM   Please return this form
and cheque by post to Ruth Jeanes
School of Sport and Tourism and the Outdoors
Greenbank Building
University of Central Lancashire
Preston PR1 2HE
               
I wish to book a place at "Children, Youth and Leisure" 14 April, 2010, University of Central Lancashire, Preston
MS / MR / DR / PROF          Forename                                                           Surname
Company/Organisation/Institution
Position

Address and post code

 

Email

I consent to my email address being given to Workshop members:              yes             no          
Telephone
Signed                                                                                                                            Date
Payment Terms         Returning this form constitutes a firm booking. Receipts will be issued within twenty eight days after the Workshop.
FEE    Please tick one option below (both options include lunch)

£35    

£25     student (please attach student ID evidence with payment)    
Special Dietary Requirement, Please state:
PAYMENT    Please tick chosen option

CHEQUE      Cheques should be in Sterling and made payable to 'UCLan Business Services Ltd.'

INVOICE      I enclose a purchase order/letter from my organisation and wish to be invoiced.
Purchase order number must be included

CREDIT / DEBIT CARD 
  

Please charge my Visa/Maestro* card with the total amount shown here:
[Diners Club and American Express not accepted]

     £
Name of card holder
Address of cardholder
Card Number:
Valid from date: mm / yy                                Expiry date: mm / yy                           Issue no:
Signature:

 CONTACT Ruth Jeanes Phone: 01772 895717 rjeanes@uclan.ac.uk