SMIB registration form

Previous name

Please tell us any previous name you have used that would help us link this registration to any other records we may hold for you

Date of birth (DD/MM/YYYY)

Gender

MaleFemale

Email address

Telephone number

Job title

Employer/business name

Your mailing address

We will use this address to send letters and qualification certificates.

Department

Company

Address 1

Address 2

Town/city

County

Postcode/ Zip Code

Country (if outside the UK)

Special Requirements

Where did you hear about us?

Do you consider that you may require us to make adjustments to your studies or examination attendance?

Yes (if this box is ticked a member of staff will contact you)
No

Registration details

Please indicate your preferred start date for the course.

The registration fee is £1010 and includes access to online learning support materials
A study timetable is available on the SMIB webpage

Payment

I would like to pay by,

Invoice
Credit/debit card (follow instructions after submitting your details)

We will use and protect your personal data in accordance with current data protection legislation to process your application. Further details, including your rights, the disclosure of data to third parties, storage, retention and how to amend your personal data, can be found within our Privacy Notice.

Declaration:

I declare that the information contained in this form is true and accurate and consent to the processing and use of personal data as outlined in the Privacy Notice.

If you have any queries regarding this qualification please contact customerservices@libf.ac.uk