CIMA Course Booking Form1. YOUR DETAILS

Surname

Forename

Date of Birth

CIMA Membership No.

Email (Primary)

Email (Addi�onal)

I have read and consent to the terms and condi�ons 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: study@icoun�raining.com

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 Sec�on 4) I am self-funded (go to Sec�on 5)

Please enter a delivery addressif the Course Type is either ‘Live Online’ or ‘Online’:

Delivery address