| Name(s) | |
| Address | |
| Postcode | |
| Home phone | Work phone |
| Mobile | E Mail |
| 1st course/event title | |
| Start date/time | |
| 2nd course/event title | |
| Start date/time | |
| I enclose a payment of £ | |
| (Please make cheques payable to FWBO (Ipswich)) | |
| How did you hear about us? (Please tick): Evolution shop/Centre foyer Poster elsewhere Newspaper advertisement Word of mouth Our website Already use Centre Other (please state)____________________________________ |
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| Please tick here if you would prefer us not to keep your contact details on record . (We will not pass this information on to any other organisations). | |
| Please complete this form and send it with your payment to: Higher Evolution Centre (Booking), |
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| (Office use only) Booked in by: Called to confirm by: on (date): |
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