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Booking Form
Please print this form and post to:-
East Anglian Sea School Ltd. Suffolk Yacht Harbour, Levington, Ipswich, IP10 0LN
Or
You can download it here, and email it to us at sales@eastanglianseaschool.com
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| First Name |
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Date of Birth |
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| Surname |
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Occupation |
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| Address Line 1 |
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Home Telephone |
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| Address Line 2 |
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Work Telephone |
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| Town / City |
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Mobile Telephone |
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| County |
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Email |
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| Post Code |
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Medical Conditions |
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Course Details
| Name of Course |
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No. of places required |
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| Date (1st choice) |
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Date (2nd choice) |
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Other information
(e.g. Vegetarian) |
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Switch / Mastercard / Visa - Card number: _________________________________
Expiry Date:___________________
Issue Date or Issue Number:__________________
Last 3 digits of security code on the reverse side of the card: ________
or You can Call us with these details.
If you wish the balance of your course fee to be deducted from this card on the due date Yes / No
Could you please ensure that your full address and post code are clearly completed above.
I enclose a deposit of £130 [or the full fee of £________] for each place booked, payable to EASS LTD.
In signing this form I agree to the conditions of booking.
I and those for whom I am booking are to the best of my knowledge physically fit to take part in this course[s]
Have you trained with the EASS before: Yes No
Previous experience / certificates:___________________________
Please Read the Term and Conditions
Telephone reservations must be confirmed with the above form within five working days.
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