Creative Movement Application Form

The course you are booking on is:

Date: Saturday 14th January Venue: Brighton - City Gate Centre
(Please complete and print this form and enclose a £10 deposit)

Name:

Address:


Town:
County:
Postcode:
Country:

Telephone:
Mobile:

Email Address:

Any comments or questions:

Please complete and print this form by clicking File/Print. Please send the completed form with your £10 deposit to the address below.

MIW will acknowledge your booking as soon as possible after receipt of your application and deposit. Cheques will be banked once booking has been confirmed. Please make cheques payable to MIW and send together with completed form to:

Movement in Worship,

City Gate Centre, 84-86 London Road, Brighton, East Sussex, BN1 4JF

Tel: 01273 693807 Fax: 01273 682248 Email: office@miw.org.uk

Movement in Worship Office Use Only:

Date Rcvd:	Amount Rcvd:	Acknowledged:	Confirmed:	Banked: