CSC Seminars

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.