PERSONAL DETAILS (Please note that the name and title you give here will be printed on your VISA document, badge and the participants' list.)

Personal Details

Title *

Surname: *

Forenames: *

Organisation / Institute / University Name*

Designation / Status *

Address:

City:*

Country:*

Business Tel. No.*

Mobile Telephone No.*

Email Address:*

Date of Birth:*

Passport No:*

Do you need UK Visa to participate in the programme (tick mark)* Yes No

Important Note:

Deadlines : Registration must be electronically submitted, faxed or mailed no later than the dead line given. Please use one form per person. If you should have problems registering, please contact the College.

Payment Information : Registration form must be accompanied by full payment in order to be processed. (Payment can be made by Demand Draft/Cheque payable to Birmingham College. For Wire Transfer information

Bank : HSBC Plc Account name: Birmingham College Ltd

Address :34 Poplar Road, Solihull, West Midlands - B91 3AF, UK.

International bank account number : GB28MIDL40421282107341

Sorting code/Brach code : 40-42-12

Swift code : MIDLGB2155G Account number: 82107341.

By sending in this registration form, I agree terms and conditions of the programme / course.

Application's Name: *

Date : *

Data Protection

The personal information entered on this form will be retained on the Birmingham College database for research purposes. Your details will unavailable for those outside the Birmingham College. Your comments may be used by the Birmingham College for marketing purposes in publications or on our website.