If not paying online, please complete the form by typing into the coloured areas; or choosing the relevant option from the drop down lists
then print it and send
the completed form with a cheque covering the deposit to:
Atisha Buddhist Centre,
9 Milton Street,
Darlington,
DL1 4ET
Title
First Name
Surname
Address Line 1
Address Line 2
Address Line 3
City / Town
County
Postal Code
Telephone
(Code / Number)
Email
Date of Course (DD/MM/YY):
/
/
Date of Booking:
/
/
Number of People Booking for:
Course / Event Title:
Total
Course / Event Fee:
Deposit Paid
(Non Refundable)
(Min. 25% per
Person)
Special Requirements: (Yes / No)
(e.g.. Disabled Access / Diet)
If Yes:
Please give details:
Have you visited
Atisha Centre before?
(Yes / No)
If No: then please give details of where you heard about Atisha Buddhist Centre
Would you like to be put on our Free Monthly Email mailing list ?
(Yes / No)
If yes please fill in
your Email address.
Please make cheques payable to Atisha Buddhist Centre