CIMA Course Booking Form 1. YOUR DETAILS Surname Forename Date of Birth CIMA Membership No. Email (Primary) Email (Addional) I have read and consent to the terms and condions and privacy policy as displayed on the iCount website. 2. COURSE REQUIREMENTS Paper Course Type Course & Time Start Date Price (e.g: BA3, P2,E3) (e.g: Taught weekend, Revision weekday) (Inclusive of VAT as per brochure) Total inc. VAT 4. EMPLOYER 5. OTHER PAYMENT 6. OUR CONTACT DETAILS Please save & then email your completed form to: [email protected] As you are self-funded, we will contact you for payment details. Manager Name Manager Email Manager Telephone PO Number I consent to feedback on my progress being provided to my employer at their request. Billing Address Manager’s Signature (Print form and obtain signature for approval to invoice) Email for Invoice Telephone (mobile) 3. PAYMENT Employer to be invoiced (go to Secon 4) I am self-funded (go to Secon 5) Please enter a delivery address if the Course Type is either ‘Live Online’ or ‘Online’: Delivery address