| First Name___________________________ | Surname_____________________________ | |
| Company____________________________ | Title/Role/Job ________________________ | |
| Personal Address______________________ | Company Address_____________________ | |
| ___________________________________ | ___________________________________ | |
| ___________________________________ | ___________________________________ | |
| _______________ Postcode_____________ | ________________Postcode____________ | |
| Home Tel No.________________________ | Business Tel No.______________________ | |
| Home Fax No.________________________________ | Business Fax No.______________________ | |
| Home e-mail _________________________ | Business e-mail _______________________ |
| Please use my Home/Business address for correspondence (Delete whichever is not applicable) | |||||||||||||||||||
| Experience in SML: __________________________________________________________ | |||||||||||||||||||
| _________________________________________________________________________ | |||||||||||||||||||
| _________________________________________________________________________ | |||||||||||||||||||
| How are you planning to apply SML? ____________________________________________ | |||||||||||||||||||
| _________________________________________________________________________ | |||||||||||||||||||
| _________________________________________________________________________ | |||||||||||||||||||
| FEES AND PAYMENT DETAILS: | |||||||||||||||||||
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| I/We* enclose a cheque for £ ________ made payable to 'Centre for Self Managed Learning' | |||||||||||||||||||
| Signed ____________________________________ Dated __________________________ | |||||||||||||||||||
| Membership runs from lst June each year. Please return this form with your remittance to: |
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| Liz Barlow, Centre For Self Managed Learning, 1 Nash's Farm, Aston Abbotts, Aylesbury, Bucks. HP22 4NT. If you have any queries, please email Liz Barlow. | |||||||||||||||||||
CSML Network is a network attached to the Centre for Self Managed Learning Limited which is a 'not for profit' organisation and company limited by guarantee, registered in England No : 2814910
This site's URL is: http://www.selfmanagedlearning.org