Academic Programme
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Are you 18 years of age or older?
*
How did you hear about this programme?
If you are not on our email list, would you like to be added?
Type yes to indicate that you have read and understand that the academic programme dates are .....
*
Type yes to indicate that you have read and understand that the venue of the academic programme is ....
*
I consent to photography for archival or promotional purposes.
*
yes
no
Note:
Payment is essential to confirm a booking.
Full advance payment is required because the programme is taking place off site at Culture House
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