Course Booking Form

Please complete this form as fully as you are able, the information you provide will enable us to give you the best possible learning experience

If returning this form by post please send to:
DrugTrain Booking Service, 120 Pontefract Road, Hoyle Mill, Barnsley, S71 1JA

PDF version, this will open in Adobe Reader.

Word version, this will open in Microsoft Word.

If you would like this document in another format or you are having problems
completing it, please call us on 01226 738 321

The Course

Course Title
Venue Date/s

About You

Your Name

As you would like it to appear on your certificate

Address for correspondence

Telephone
Mobile
Postcode

Email Address

Please ensure this is spelled correctly

Organisation Job Title

How would you like us to contact you? (please ensure your chosen method is completed correctly above)

Post Email Phone SMS Text

Anything else you want us to know? (learning needs, access issues, dietary requirements etc.)

Payment

How would you like to pay?

Cheque

If you are paying by cheque, please make it payable to DrugTrain and it must be received at least 2 weeks before the start of the course

Invoice

If you would like us to invoice your organisation, please state:

I agree to pay DrugTrain the sum of
Discount code?

Before submitting this booking form please read the Terms and Conditions which can be found at www.drugtrain.org.uk/t&c.html

I have read and agree to the terms and conditions