Printable Enrolment Form - Evening

Please complete the details on this Form, print it using your browser print command, and fax or post to the address below:

THE LONDON SCHOOL OF JOURNALISM
126 SHIRLAND ROAD
LONDON
W9 2BT
ENGLAND
FAX: (+44) 207 432 8141

Please select the course for which you would like to register:
20 September 2017: £385.00 Journalism Evening Class
4 October 2017: £365.00 Creative Writing Evening
5 October 2017: £365.00 Go Freelance Evening Class
22 January 2018: £385.00 Shorthand Course
 
Please complete the following details:
Title:
First name:
Last name:
Company:
Occupation:
Date of Birth:
Address:
City:
State/Province/Region:
Country:
Postcode:
Telephone:
Email:
 
Please enrol me on the above course in accordance with the LSJ standard terms and conditions. Payment of fees will be made as follows:
  Please charge my credit card with full payment now, or
  Charge the deposit of £175.00 to my card now and charge the balance fourteen days before the course start date
or:  
  I enclose a cheque for the course fee in full payment, or
  I enclose a cheque of £175.00 as a deposit and will pay the balance not less than fourteen days before the course start date
Credit card type:
Card Number:
3 Digit Security Code: (This is printed on the back of your credit card)
Expiry Date:  /  (mm/yyyy)
Issue Date:
(Switch)
 /   (mm/yyyy)    Number: 
Your name exactly as shown on your credit card:
 
Address on credit card statement If different from delivery address:
 
Please also give your name and address if this is a corporate order:
 
 
Please help us by supplying the following information:
Purpose of taking this course:
 
Have you had work published previously?
 
How did you hear about the school?
 
Signed:
 
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