Please complete this form and return toConverge, Leeds Mind, Clarence House, 11 Clarence Road, Leeds, LS18 4LB or email to converge@leedsmind.org.uk BASIC INFORMATION: Form originally completed by: Date: Student name: Date of birth: Address: Post code: Telephone (Mobile): Telephone (Landline): Email: How would you like to be contacted? Please tick as many boxes below as needed Call to Call to Mobile Text to Mobile Post Email Landline What course(s) are you interested in? Please tick the box below. Drama Electronic Music Health and Songwriting Converge Production Nutrition Singers The University of Beckett University Leeds Trinity Leeds College of Leeds College of Leeds University Music Music did you hear about Converge courses?
Please complete this form and return toConverge, Leeds Mind, Clarence House, 11 Clarence Road, Leeds, LS18 4LB or email to converge@leedsmind.org.uk BASIC INFORMATION: Form originally completed by: Date: Student name: Date of birth: Address: Post code: Telephone (Mobile): Telephone (Landline): Email: How would you like to be contacted? Please tick as many boxes below as needed Call to Landline Call to Mobile Text to Mobile Post Email What course(s) are you interested in? Please tick the box below. Drama Electronic Music Production Health and Nutrition Songwriting Converge Singers The University of Leeds Beckett University Leeds Trinity University Leeds College of Music Leeds College of Music did you hear about Converge courses?
Converge-student-enrolment-form-2018-19.docx