COURSE NAME (required)

    Delegate(s) Name(s)

    School Organisation (required)

    Address (required)

    Telephone Number (required)

    Fax Number

    Email Address (required)

    Dietary Requirements (e.g. Vegetarian)

    Invoice Required?

    YesNo

    Payment by Cheque (cheques to be made payable to HEADS)

    YesNo