The Bognor Club

The Bognor Club

Course Application Form
2 Sudley Road, Bognor Regis, West Sussex, PO21: 1EU

Please complete and sign the application form and click to submit. Any further information about the beginners' course can be obtained from Lesley Simmons on 07900077454 or email lesley.simmons@hotmail.co.uk
NAME OF APPLICANT
TITLE
ADDRESS
POST CODE
TELEPHONE NO (LANDLINE)

Area CodePhone Number
TELEPHONE NO (MOBILE)

Area CodePhone Number
E MAIL ADDRESS
example@example.com
ARE YOU HAPPY TO BE CONTACTED BY E-MAIL IN FUTURE?

YESNO
I CONFIRM THAT, TO THE BEST OF MY KNOWLEDGE, THE INFORMATION I HAVE PROVIDED IS ACCURATE AND CORRECT (PLEASE TICK BOX)
DATE

MonthDayYear
Date
1: Payment of £48 for the first term is payable directly to the teacher at the beginning of the course (first lesson) Alternatively, you can pay by bank transfer: sort code 20-20-65; account number 40292397. Please include your name in the reference section. Please inform our secretary Lesley Simmons if you have paid by bank transfer (phone number/ email address as above)
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