Enrolment Form
Please return to:
Higham Hall, Bassenthwaite Lake, Cockermouth, Cumbria CA13 9SH

I wish to attend the following Course as: Resident Non-resident
Course:
Dates:
Full Fee or Deposit:
TOTAL AMOUNT ENCLOSED:
First Name:
Surname:

Address:

 

 



Postcode:
Tel. No. (Day):
E-mail
Special diet or vegeterian
Bedroom requirements: single double twin-bedded en-suite (if available)
if there is no accommodation available, I would like to know about local bed & breakfast accommodation YES/NO
 
I wish to pay by:     Cash     Cheque               
 
To MASTERCARD/VISA/MAESTRO
I authorise you to debit my account with the amount of : £
 
card number
security No. (last 3 digits on the back of card)


signature: .........................................................................................

Name (as on card)
Expiry date:
Issue No. (Maestro):