Enrolment form for Distance Learning Journalism and Creative Writing courses from the London School of Journalism

Distance Learning Enrolment Form

To enrol on the course you have chosen, simply select the name of the course, the type of course (UK, Non-UK or online), and how you wish to pay. Use the keyboard to complete the other enrolment details. Print a copy of the completed form using your browser 'print' command. Please read a copy of our Terms and Conditions as this document forms part of a legally binding contract.

Course name:
Course type:
Payment method:
If you want to check the fees due, click here before completing the boxes below
Ł	I enclose the amount shown in accordance with my instructions below
	Payment (cheque, money order or draft) in full for the course(s) that I have chosen.
	Payment (cheque, money order or draft) as deposit for the course(s) chosen and I will pay the balance by monthly instalments.
Or:
Ł	Please charge my Access, Mastercard or Visa credit card with the amount shown in accordance with my instructions below.
	As full payment of the amount due for the course(s) I have selected.
	As the initial deposit due and then with the amount of each subsequent instalment due in respect of the course(s) I have selected.
Credit card type:
Card Number:
Expiry Month/Year:
If the cardholder is not the student, please give full name and address of the cardholder as shown on the relevant credit card statement:


Name and details of Student:
Family Name:
First Name:
Title:	Other title:
Date of Birth:
Occupation:
Address detail:

County/State:
Postal/Zip Code:
Country:
Email Address:
Telephone No:
Signature:

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