Learning Unlimited Application Form

Functional Maths for non-numeracy specialists2pm-5pm on Thursday 12th February 2015at Learning Trust, 1 Reading Lane, E8

Participant’s DetailsTitle Name SurnameJob TitleOrganisationAddress

PostcodeTelephone Email address

Payment DetailsTotal cost per person: £65A I enclose cheque no. (made payable to Learning Unlimited Ltd)B I have made a BACS transfer for the above sum to Learning Unlimited Ltd

Bank – Co-operative Bank PLC, Sort-code - 08-92-99, Account number – 65489297Reference number: Date:

C Please send an invoice to:Purchase order number (if applicable)NameAddress

Learning Unlimited Booking Conditions and Cancellation PolicyFull payment must accompany bookings. For a refund to be given, cancellations must be received in writing at least two weeks prior to the event. In this event, 20% of the fee will be retained to cover administrative charges. If less than two week’s notice is given, a refund will not be made. Substitutions may be made at any time. In the event of the session being cancelled, delegates will be notified one week prior to the advertised date of the CPD session and a full refund will be given. Learning Unlimited does not accept responsibility for the views and opinions expressed by individual trainers. Learning Unlimited reserves the right to alter the programme or trainers without prior notice.

Learning Unlimited will use its reasonable endeavours to provide the course at the venue on the advertised date. Learning Unlimited shall in no event be under any liability in respect of any loss or damage whether direct, consequential or otherwise arising from any delay in providing the course or in any change of venue of the course.

Please note that places are limited, and can only be reserved on receipt of payment in advance

Equality and DiversityLearning Unlimited is committed to equal opportunities and widening participation in all its work. Please complete the following information for monitoring purposes and we will make every effort to provide you with any additional support you require.Date of birth: Age:Gender: Male / Female (please delete as appropriate)Nationality:First languageDo you have a disability? Yes / No (please delete as appropriate)

NB: Learning Unlimited tutors are able to adjust their teaching style or arrange special accommodation to support your individual learning needs. Please speak with your tutor if you have a disability or learning difficulty which might require any such adjustments.

Which of the following best describes your ethnic origin?White – British Asian – Indian Mixed White/Black African

White – Irish Asian – Pakistani Mixed White/Asian

White – Other Asian – Bangladeshi Mixed other background

Black – Caribbean

Chinese Latin American

Black – African Asian – Other Asian Background

Other: please state:

Black – Other Black background

Mixed White/Black Caribbean

Not prepared to say

NB - Personal data collected on this form will only be used for administration purposes, and will not be disclosed to any third party without your written consent.

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How did you find out about usLearning Unlimited website Learning Unlimited email Other website Twitter Facebook Email from another source Word of mouth Other: please specify

Please send the completed form and payment to Julia McGerty, Learning Unlimited, Institute of Education, 20 Bedford Way, London WC1H 0AL | 020 7911 5561 | julia.mcgerty@learningunlimited.co