Debate @British The game of the elites Registration Form - Debate @British Club, Winter 2016 Please fill in with capitals: Family name First name Date of birth Mobile phone E-mail address (Optional) Company The autumn debate courses will take place between 23 January – 25 February 2016. There are two timetable options: 1. Once per week: on Saturdays, between 23 January – 20 February, 10:00 – 14:15 (with a 15 minute break) 2. Twice per week: on Tuesdays and Thursdays, between 26 January – 25 February, 19:00 – 21:00 (no break) Please tick below the timetable option you choose to register for. If you can attend the courses on any of the days listed, please tick both options in the preferred order (option 1 and option 2). Option 1 ☐ Saturdays, 10:00 – 14.15 ☐ Tuesdays & Thursdays, 19:00 – 21:00 Option 2 (if applicable) ☐ Tuesdays & Thursdays, 19:00 – 21:00 ☐ Saturdays, 10:00 – 14.15 Please tick below the module you are registering for: ☐ Theoretical Module ☐ Practice Module (for the Theoretical Module graduates) ☐ Module C How did you find out about the Debate @British club? ☐ ☐ ☐ ☐ Recommendation from a friend British Council flyers British Council website British Council newsletter (InBrief) ☐ ☐ ☐ ☐ Web search engine Facebook Other activities of the British Council Others/ other website …………….…………………… British Council might use your photograph(s) for the purpose of promoting British Council activities. This may include placing your photograph(s) in our publications, on our websites and in our promotional materials. If you DO NOT WISH for your photo or any materials created by you to be used by the British Council for any of the activities mentioned above, please tick this box ☐ From time to time, we may wish to contact you to make you aware of our relevant services and events. If you DO NOT WISH to receive this information, please tick this box ☐ The signature confirms that you have read and understood the terms and conditions of our registration/refunds policy. Signature For office use only Payment date Payment method Amount Administrator Date