British Institute of Learning Disabilities

Booking Form

Use this form to book online if you are paying by invoice.

To pay by credit card or cheque, print the page and send the completed form to:

BILD, Campion House, Green Street, Kidderminster, DY10 1JL

Telephone 01562 723025

Fax 01562 723029

learning@bild.org.uk

Please note that your completion and submission of this booking form is taken as your acceptance of our terms and conditions.  Cancellation charges apply.  BILD will contact you with your joining instructions no later than 14 days before the course date.

Organisation details
BILD Membership Number (if a member)
Organisation name

Full address
Postcode

First delegate
Surname
Mr/Mrs/Ms/Miss/Dr/Other
Forename

Additional requirements

(dietary, access, communication)

Telephone No.

Fax No.

email address

May we send you details of our other services

by email?

Second delegate
Surname  
Mr/Mrs/Ms/Miss/Dr/Other  
Forename  

Additional requirements

(dietary, access, communication)

 

Third delegate

Surname

  

Mr/Mrs/Ms/Miss/Dr/Other

  

Forename

  

Additional requirements

(dietary, access, communication)

  

Event details

Event code

(please specify exact code)

 

Event title

  

Event date

  

Event location

  

Financial Details

No. of delegates

  

Price per delegate

  

Total amount

 

Purchase order no.

  

Purchase order approved by

 

 

           

 

I am paying by cheque

Cheques should be made payable to BILD and posted to the address below.

I am paying by credit/debit card 

We regret that we cannot take payments online.  Please print this form, complete the details below, and return it to:

BILD, Campion House, Green Street, Kidderminster, DY10 1JL

Telephone 01562 723025   Fax 01562 723029

learning@bild.org.uk

 

Please debit my credit / debit card

[    ]  (tick the box)

Expiry date

 [    ]  [    ]  /  [    ]  [    ]

Card type

 MasterCard [    ]   Visa [    ]    Switch [    ] (Issue no. [    ])
Card no. [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ] [    ]
Security number [    ] [    ] [    ]  (last three digits of number on signature strip of card)
Signature:  

                                                                                                

Date: