REGISTRATION FORM

Please complete all fields Surname/Family name Forenames (in full) Status MrMrsMissMsOther Date of Birth Your Harley Reed Study Centre Country Street City County Post code The country where you are living Home address (including postal address) Home telephone Mobile telephone Home Email Name of employer Work address Work telephone Delivery address for study pack (Home or Work) Work Email Job Title Email for site login and preferred communications Home EmailWork Email

Note : All communications/notifications will be sent to the selected email address.

Membership No. (if applicable) ie. CIPS,ACCA,CILT If you are not already holding a membership number, for some courses Harley Reed is able to invoice you and process your membership. Please state if you would like Harley Reed to do this. Note this is not available for all courses

Disabilities and special needs Do you have a disability or are you aware of any additional study support requirements? YesNo Please provide details if any

Please write clearly Please provide details of your educational background and qualifications gained.

Please write clearly No. or years of work experience in a business environment Please provide a short summary of your current accountabilities within your company.

Please write clearly Intended payment method (*card transactions on corporate cards attract a processing fee) BACSCash/ChequeCardOther Invoice details(Name and address to which invoice must be generated) What Month/Year do you intend to next enter for a professional examination Please state if you would like Harley Reed to invoice you and process your exam entry on your behalf (where applicable) Estimate required before invoice? Purchase order number (if applicable)

Training modules Please indicate Training modules required

Please ensure you have read all guidelines before selecting your learning method. Prior to submitting your registration form, consult Harley Reed's training advisors if you have any queries. Mark your chosen selection with a tick and only select papers you intend to be invoiced for. If you wish to take advantage of a level discount by paying in advance, select all modules from the level. Please note all our learning programmes include the Study Guides.

Please select from this list of modules

Preferred method of delivery

Please select preferred method of delivery as detailed in the Harley Reed student information pack document. Please note, these delivery methods will be employed subject to student volume and demand.

Platinum

Gold

Silver

eLearning Only

Please refer to timetable for dates of classes and revision

Terms and Conditions

By ticking this box, I agree to the terms and conditions found here:www.harleyreed.com/images/downloads/trainingterms.pdf.

I declare that the information contained herein is accurate to the best of my knowledge. Fraudulent declarations may lead to prosecution.

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