YOU MUST COMPLETE AND SIGN THIS FORM TO BECOME A REGISTERED OPEN UNIVERSITY STUDENT. PLEASE USE BLOCK CAPITALS. ROMAN CHARACTERS

Initials

Day Month Year

CATEGORIES LAM YAM DUP VET

Male Female

Address

Applicant's signature

Date

Name

The information given above is accurate to the best of my

I will abide by the University's rules, regulations and conditions of software use.

80

Presentation Starting date

Study Centre Region

Surname

Your date of birth

Applicant's declaration

01 Y

Personal identifier Date received

Title

OFFICE USE ONLY

1.

2.

3.

4.

5.

6.

7.

8.

Course code

912

knowledge.

11. I wish to pay by:

(Access)

Switch Personal cheque

Expiry Date:

13.

Please specify your required video format:

NTSC PAL SECAM

?

VISA

Please debit my account with the amount of:

My card or Switch number is:

Mastercard

Issue number (Switch cards)(all cards)

We asked about ethnic origin so that the University ca monitor its equal opportunities policy. Please enter the one code from the list which best describes your ethnic origin.

9. What best describes your current situation?

(See the code list)

10. Job

Code

Job

12.

f:eur
ope/lHCRL