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Non-residential courses online booking form

Course name	Dates	Closing date	Sector
SSERC Annual Conference and AGM	Friday 3 December 2010 - Friday 3 December 2010	26/11/2010	Conference
Radiological Protection	Wednesday 17 November 2010	27/10/2010	Secondary
Radiological Protection	Wednesday 12 January 2011	08/12/2010	Secondary
Radiological Protection	Wednesday 8 June 2011 - Wednesday 8 June 2011	18/05/2011	Secondary
Health & Safety Update	Monday 17 January 2011 - Monday 17 January 2011	10/12/2010	Secondary
Risk Assessment	Tuesday 25 January 2011 - Tuesday 25 January 2011	17/12/2010	Secondary

Please select the course for which you wish to apply by selecting from the drop down list.

Items marked (*) are required

* Title:
* Surname:
* First name (s):
Home Address Line 1:
Home Address Line 2:
Home Address Line 3:
Home Postcode:
* I am a:	Teacher PT Head of Faculty Head of Science Technician Other (please specify)
Subject specialism:
* Telephone:
* Email:
* This email address may appear in the delegate pack	I agree I don't agree

Choose your LA and then school from the drop-down lists below
Education Authority
School
OR If your school or organisation is not listed, please enter name and details below
Organisation Name:
Address Line 1:
Address Line 2:
Address Line 3:
Postcode:

Invoice address (if different from above)
Organisation Name:
Line 1:
Line 2:
Line 3:
Postcode:

* Please provide a brief statement about how you will benefit from this course:
* Do you have any special dietary requirements? (please tick one box)	Yes No
if yes, please indicate nature of requirements:
Special Access requirements:

Places for courses will be allocated on the closing date, you will not hear if you have a place until shortly after that date.