Training Course Application Form

Personal Details

Title (Mr. Mrs. Miss. Ms. etc.)

First Name

Last Name

Address

Street & Number

City / Town

Postal Code

Primary Email Address

Contact Numbers

Registered Members/Accredited Professionals

Are you registered with a professional body?

Yes

Name of Professional Body (Please State)

Write Here

Will you be using this course towards your CPD requirements?

Yes

Course(s) Applied For

Have you attended any CPD courses with Infinity Addiction Solutions Ltd before?

Yes

If yes, please state details, if known

Write Here

Please state how your attendance on this CPD course(s) will be funded. Complete one section of this page only and sign both sections below.

Training & Consultancy Terms & Conditions

How Will You Fund Your Course?

Self Funding

Employer

Other Funding

1. Self-Funding

An invoice will be sent to you at the address you have given overleaf. You must make payment once we have confirmed your attendance, payment must be received no later than 28 days before the course start date.

2. Invoice for Employer

I agree to pay the fees for the applicant to attend the course(s), the details of which are shown overleaf and have read and agree to terms and conditions.

Employer Address

Name of Employer

Employer Street & Number

Employer City / Town

Employer Postal Code

Employer Phone

Data Protection

Infinity Addiction Solutions Ltd collects, stores and processes personal data about its delegates for the purpose of preparing, delivering and managing their chosen CPD course, its contents and all other services provided to them by the organisation. The information held and processed may be disclosed to the senior management team at Infinity Addictions Solutions for the collection of auditing statistics. The CPD standards agency, national and local government education regulatory departments, funding councils, sponsor organisation’s, other educational establishments and other relevant bodies. The organisation keeps a record of its past delegates electronically in perpetuity. The purpose for keeping the records is as an archive of graduates and delegates who have attended the course and its services.

I understand that the personal data supplied will be used only for the purposes described, and I agree to my personal data being stored and processed for these purposes.

I confirm that the information shown on this form is accurate and complete and I have read and agree to Infinity Addiction Solution’s terms and conditions.

Signed Employer - By ticking this box you are signing that you consent to the above.

Signed Applicant - By ticking this box you are signing that you consent to the above.

Date

Select Date ×

3. Other Funding

Please indicate funding arrangements, including name and address of funder. We will issue the funder with an invoice on receipt of the completed application form. Payment must be made 1 month before course attendance.

Name of Funder

Write Here

I Agree to Fund

Name of Applicant

Please Invoice Me At

Name of Funder

Funder Street & Number

Funder City / Town

Funder Postal Code

Signed Funder - By ticking this box you are signing that you consent to the above.

Date

Select Date ×

Form successfully restored

Contact Numbers

Please provide details below of any special adjustments you require as a result of any disability(s) (leave blank if no special adjustments are required)

1. Self-Funding

2. Invoice for Employer

Data Protection

3. Other Funding

Your form has been submitted