Love is a Verb - Registration Form

Title:	Gender:	FemaleMale
First Name: *	Surname: *
Address: *

Town:*	Post Code:*
Daytime Phone:	Mobile Phone:
Email Address:*	Date of Birth:

Please give your reason for wanting to do Love is a Verb. What would you like to get out of it and what do you hope to learn?

Please select a course location:

What Church do you attend?	How long have you attended?

Please give name and phone number of Church Leader:

How did you hear about Love is a Verb?

Are others from your church attending Love is a Verb?	YesNo
Would you like to be in the same group?	YesNo
How did you hear about us?

Local church		Recommended by current participant or trainer
Web	Brochure	Other (please specify)

Course Fees

Discounted Rate: £260 – early bird fee to be paid by 1st September

Full Rate: £25 due now plus two payments of £135. Total cost: £295

Bursary Rate: (for low income participants) £20 due now plus two payments of £85. Total cost: £190

Apply for bursary rate by e-mail to info@catalysttrust.org

Costs include weekend away and training manual. Evening meal not included. The cost of evening meals will be £3 each night in cash.

I will be paying the following now: *(required)
£260 - discounted early bird
£25 deposit plus two payments of £135 – full rate (payable at the start of each term)
£20 deposit plus two payments of £85 – bursary rate (payable at the start of each term)

* By enrolling on Love is a Verb I agree to pay the required fees in full. Apart from exceptional circumstances, agreed in writing with Catalyst, should I choose not to complete the course, I will still be required to pay the fees due.

* I agree that the course involves my finding a placement with a local project where I will serve 2-3 hours per week. Whilst Catalyst can help you locate a project, this is my responsibility. I will be a volunteer for that project who should provide training, support, security checking and any necessary insurance. I UNDERSTAND THAT IT IS ESSENTIAL I COMMIT TO ATTENDING THE COURSE EVERY WEEK UNLESS IT IS IMPOSSIBLE TO DO SO.

NOTE: After submitting your details, you will have to pay by clicking on the PAYMENT PAGE to add your payment option to the shopping basket and proceed to make your payment by credit, debit card or cheque.

Practical Service

We would like to know where you will be doing your practical service during the course. If you already know, then please complete the Practical Service form. If you need help in finding a place to service, please let us know.

local impact, national significance