Two Day Training Course & One Day Assessment
Application Form

Course Venue: _________________________     Course Dates: ________

Name:_______________________________________________

Address: ________________________________________________

_________________________________  Post Code _____________

Telephone No:  _________________ Date of Birth: ____/____/____


BSA Membership No: ____________


Do you have any learning difficulties _________________________________

All Course participants will receive a Level I Syllabus and Surf Coaches Manual on CD on registration.

I enclose a cheque to the value of £_____ to cover the above course fees

Or: Please debit my Visa / MasterCard / Delta / Switch  (delete as appropriate)

Card number  ______ /______ /______ /______ /______ Expiry Date ______/_________

 Issue Number   /                /         3 Digit Security Number   /                       /  
Card Holders Name____________________________ Signed: __________________________ Address __________________________________________________ Date:  ______________

·     This completed form and registration fee must be sent to the BSA office at least 10 days before the start of your course.  If sufficient applications are not received the course will be cancelled and a full refund given.

·     If you are unable to attend a BSA Coaching Accreditation Course and wish to obtain a refund then you must notify the BSA office in writing 7 days prior to the start of the Course.