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Mountain Sense Booking Form (Items marked with a * are required)
Name and Title *
Email *
Address *
Main Telephone *
Mobile Telephone *
Date of Birth *
Occupation *
Where did you hear about us?
Medical Conditions *
Please indicate your previous experience and any existing qualifications where relevant.
Previous Experience *
MLTUK/MLTE/MLTNI/MLTS/MLTW Registration number if applicable
Registration Number
Please Provide details of someone we may contact in the event of an Emergency.
Emergency Name *
Emergency Telephone *
For relevant courses please indicate your preferences below.
Special Dietary Requirements
I wish to share a room with
Your Course
First Choice Course *
First Choice Dates *
Second Choice Course
Second Choice Dates
Payment Options
Full Course Fee *
Payment Type *
--please select---
I am paying a 25% deposit (If more than 56 days to course start - non refundable)
I am paying the full course fee (Mandatory if less than 56 days to course start)
I am paying the balance (full course fee minus pre-paid deposit - due 56 days before course start)
When booking a course you can choose to pay securely online via Worldpay or via a postal cheque/invoice.
Please add 2% to your payment amount if paying by Credit Card and 3% if paying by American Express.
If paying online you will be taken to a secure server when the form is submitted.
Payment Method *
--please select---
Online via Worldpay after the form is submitted
Payment by other means
Payment Amount *
Payment Amount :: The amount you are paying today.
Please copy the code into the input box.
By submitting this form you agree to be bound by the Terms and Conditions available
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