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Book me (FULL NAME):
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Date of Birth:
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Daytime and evening telephone
number:
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| On the course starting on: | |
| DATE: | TOWN: |
| DAY: | TIME: |
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Court I was sentenced in:
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Crown court / Magistrates court *
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delete as applicable
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| I enclose a cheque/postal order payable to reForm for: (tick as appropriate) |
| My full fee |
| As a non-returnable booking fee of £40 to reserve a place and I will pay the rest of the fee at least three weeks before the course starts |
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To pay by major debit/credit card telephone our
office on 0114 2811229
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Signed:
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| PLEASE NOTE: Bookings cannot be cancelled/changed within 60 days of the course beginning. Credit card payments by post can only be accepted for the full course fee |