Warwickshire Wildlife Trust
Adult Education Days - Natural Habitats

Booking Form

Please fill in the following form and send it to :

Phil Dickin, Community and Education Manager, Warwickshire Wildlife Trust, Brandon Marsh Nature Centre, Brandon Lane, Coventry CV3 3GW

I / we wish to register on the following Study day/days:

Title of Day: ___________________________ Date: ________________________

Title of Day: ___________________________ Date: ________________________

Title of Day: ___________________________ Date: ________________________

Title of Day: ___________________________ Date: ________________________

Name(s) _______________________________________

Address:__________________________________________________________________

_________________________________________________________________________

Post Code:_________________________________________

Evening Telephone No:________________________________

E-mail address:______________________________________

The fee of £7.50 per person for each day (£5 for Warwickshire Wildlife Trust members) includes a donation to the Trust's work.

I enclose a cheque to the value of £ _____ (payable to Warwickshire Wildlife Trust)

Or Please debit my Access / Visa with the amount of £______

Name on Card: ____________________________________

Card No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _   Expiry date:____________________

Signature:_______________________________________

(Office use ackn. ) Registration form

Fax 024 7663 9556 Internet www.wildlifetrust.org.uk E-mail admin@warkswt.cix.co.uk

Warwickshire Wildlife Trust is a company limited by guarantee Registered in England No. 585247 Registered Charity No. 209200 VAT No. 607 3187 40