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Course Registration

 Please complete the form below OR Click here for a printable PDF course registration form which you can either fax or post back to us: 
    
 

Name:

 *
(This is how it will appear on your certificate)		 
 
Address:
 *  
 

Postcode:

 *
 
Telephone:
 *  
 
Email Address:
 *  
 
Course Location:
 *  
 
Course Date:
 dd-mm-yy 
 
Waiting list:
 Please tick if course is showing FULL 
 
I will bring:
 pets for microchipping 
 
I will bring a friend as an observer:
 
 
'I am attending as':
 *  
 
Pricing:
 *  
 
Name of Rescue:
  
(Required field if attending on reduced fee)		 
 
Name of Council:

  
(Required field if attending on reduced fee)		 
 
Name of Veterinary Practice:

  
(Required field if attending on reduced fee)		 
 
How did you hear about us?
* 
 Details of 2nd Student (Not the observer) 
 
Name:
   
 
Address:
  
 
Postcode:
   
 
Telephone:
   
 
Name of Rescue:
  
(Required field if attending on reduced fee)		 
 
Name of Council:

  
(Required field if attending on reduced fee)		 
 
Name of Veterinary Practice:

  
(Required field if attending on reduced fee)		 
 
'I am attending as':
  
 
Pricing:
  
    
 Payment Information: 
 Card Type: *  
 Card No: *
(no spaces)		 
 Start Date:   *  
 End Date:   *  
 Issue Number: (if applicable)  
 Security No. (last 3 digits on signature strip on reverse of card): *
 
Please enter the image code you see in the picture below:

 *
  * = required field  
    
   
 

 
• If you cancel this booking you can book another venue or date.
• We will confirm your booking by email.
• Maps available on the course locations page.
• Course Fee includes:
Up to three animals microchipped on the day of the course plus their Petlog lifelong registrations, certificate signed by course vet and tutor, training manual and folder, laminated poster. Bring along a friend as an Observer.
• Once trained, you can attend a refresher course at any venue at no additional charge.

 
    
  
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contact us for details on
0207 483 1118 or
info@pet-detect.com
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