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CSC SUPPORT PROGRAMME REGISTRATION FORM
Please ensure that you complete all fields on this application form
NAME: ADDRESS:
NI NUMBER: SELF-EMPLOYED?
Yes No
BUSINESS NAME: BUSINESS ADDRESS:
CONTACT NUMBER: CONTACT EMAIL:
DESCRIPTION OF BUSINESS:
DATE BUSINESS STARTED (DD/MM/YYYY):
NUMBER OF EMPLOYEES:
SUPPORT PROGRAMMES:

If you have more than one choice, please mark in order of preference with 1 being your first choice. You can select up to four options.*

*Please note: You will be placed on a maximum of 2 programmes only.

   
Customise your MySpace 20/09/2007
Free Membership on Fashion Enter Ends 30th September!
Understanding Online Marketing 20/09/2007
Free Electronic Catalogue Ends 30th September!
Free Website Promotion Ends 30th September!
PR Interactive Training Manual Ends 30th September!
ETHNIC MONITORING:
WHITE:
British Irish
Any other white background (please state):
MIXED:
White & Black Caribbean White & Black African White & Asian
Any other mixed background (please state):
ASIAN OR ASIAN BRITISH:
Indian Pakistani Bangladeshi
Any other Asian background (please state):
BLACK OR BLACK BRITISH:
Caribbean African
Any other black background (please state):
CHINESE OR OTHER ETHNIC GROUP:
Chinese Any other background (please state):
ADDITIONAL INFORMATION:
Date of Birth (DD/MM/YYYY):
Gender:
Male Female
Do you consider yourself to have any disabilities (including dyslexia)?:
Yes No Prefer not to say
Do you have any requirements regarding access to venues? (if applicable):
Yes No
If yes, please outline in the box below:
Please click the button below to send the registration form. Please note that it takes up to 10-15 seconds to process the form, so please be patient and click the button only once.