SL

Course Booking Form

To register for this course please fill in the following form:

Number of Delegates *

Delegates Name (1) *

Delegate Name (2)

Delegate Name (3)

Delegate Name (4)

Contact Name *

Contact Telephone No *

Contact Address *

Contact Email address *

Company Name

Company Address

Company Telephone No

Company Email Address

Course Date *

Course Location *

Payment Details (Cheque, Credit Card/Paypal, Bank Draft or Bank Transfer) *

Payment for one course

Payment for both courses

No 9, Level One, Liosban Business Park, Tuam Road, Galway. Tel: +353 91 782 830, Fax: +353 91 782 831