Course Enrolment Form

You have chosen to the following course:

Portraiture - (Advanced level)
Course reference: 1008-0771
Price: £145.00 (Concession: £110.00)

Session	Date	Start	End
1	Monday 16th August 2010	18:45	21:45
2	Monday 23rd August 2010	18:45	21:45

To this course:

First, please read our Terms and Conditions
Fill your details in the form below
Fields marked with a red asterisk ( * ) are required
Once you have completed the form, click the 'Submit' button
When we receive your form we will send you an email acknowledging receipt

To pay for this course:

You can pay either:
- by debit / credit card over the telephone
- by sending a cheque in the post

Student Details
Title *				email * If you do not have an email please enter 'None'
First Name *				Daytime Phone * You may leave this box blank if you prefer to give just your mobile number
Surname *				Mobile
House or Flat Number *				How did you hear of Zoom In? *
Street *				If 'Other' please say where
Street 2				Occupation
Town / City *				Concession * Full time students, unemployed and OAPs (proof of status must be presented on the first day of the course). Please note we cannot accept concessionary status without proof of status. This must be in the form of an NUS card, letter from Benefits Office or Pension Book. Please send a copy of proof of status with your Enrolment form and bring the original with you to the first day of your course.
County
Postcode *				Emergency Contact * For health and safety, please tell us who we should contact in case of an emergency.
Country				Emergency Contact Phone *

What is your knowledge of photography?
Beginner		Keen Amateur		Semi-professional		Professional

What areas of photography are you interested in?
Portraiture	Travel	Documentary	Landscape
Fashion	Architecture	Still Life	Studio
Other	If 'Other', please state what:

Additional Info
Please tell us anything else you may think we need to know

Equal Opportunities Monitoring Information (OPTIONAL)
Please fill in this information - it will really help Zoom In to secure future funding. These details (except for your date of birth) will be stored completely separately from the rest of your details and will not be able to be linked back to you.
Date of birth	Day Month Year		Sex	Marital Status
Ethnic Background - please select the option(s) that best describe you.
Asian		Asian - British	Black - African	Black - British
Black - Carribean		Black - other	Latino	Middle Eastern
White - British		White - European	White - other	Other
Do you have any disabilities?
No Yes		If 'Yes', please state what:

Complete the booking
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Before clicking the 'Book Now!' button please make sure you have read our Terms and Conditions To combat the amount of spam we receive through our booking forms we would be grateful if you could fill in the two words displayed below (separated by a space) before submitting your details. If you are unable to read the words there is a button which can be clicked to offer a different challenge.

"Zoom In exists to promote and celebrate individuals in the attainment of their independent goals and aspirations through the philosophy of creativity, inspiration, education, encouragement and support."

For general information please email us via our general enquiry form.
Or see our contact details for enquiries to specific departments.
Telephone for course information: 020 7793 0000 (from 10.00 - 17.00)
Telephone for Membership, Volunteering, Community Education: 020 7735 5061 (from 12.30 - 17.30)
Zoom In Limited, 301 Lincoln House, Kennington Park Business Centre, 1-3 Brixton Road, London SW9 6DE
Company Registered in England and Wales No: 03439591
Registered Charity No 1101308 - Registered Office as above

Sir Walter St John's Educational Charity

Capital Community Foundation - Local Network Fund