Printable version of this form

Application Form
for
Copywriter Protégé Program

Dear Paul,

I'm enclosing my payment for £477 plus £20 postage and packing and understand that I will also have to pay for any phone calls I make to you as part of this program.

I also agree that any of the proprietary secrets, techniques, methods, ideas, procedures or materials that I receive will be kept in strict confidence and not revealed in any form to anyone else without your written permission.

Date:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec 2004 2005 2006
Name:
Address:
City:
County:
Postcode:
Phones (Day/Evening) : (For order processing only)
FAX (optional):
Email :
Secure online payment by PayPal. You can pay by Visa, Mastercard or American Express
Amount (£) :	Postage & Packaging (£) :  Total (£) :
If you don't want to pay online by PayPal, FAX/Mail or Email the above form with your payment. If you are Emailing the form, leave off your card #/exp date and place an X here: . We'll call you for your card information.
Paul Lock Incise Communications Ltd Maple House, Bayshill Road , Cheltenham GL50 3AW Phone: 0870 420 3181 FAX: 0870 220 1751 paullock@incisecomms.co.uk

            
Printable version of this form