7763-03 L3 Diploma Booking Form Full Name* First Last Date of Birth* DD slash MM slash YYYY Full Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code E-mail* Contact Number for day of exam*Original Centre of Registration*Please SelectSummitHeavenlyzPIFOtherOther, please state* Date of registration, if known If applicable, please select previously completed unit/s*Please selectNone19 - Spaniel19 - Spaniel & 20 - Short Leg Terrier19 - Spaniel & 21 - Poodle19 - Spaniel & 22 - Long Leg Terrier20 - Short Leg Terrier20 - Short Leg Terrier & 21 - Poodle20 - Short Leg Terrier & Long Leg Terrier21 - Poodle22 - Long Leg Terrier inc SchnauzerYOU MUST SUPPLY EVIDENCE FOR ANY PREVIOUS UNITS SUCCESSFULLY COMPLETEDThis should be emailed to firstname.lastname@example.org or a copy posted to 2 Henry Street, Keighley, BD21 3DRPlease confirm that you have received your Level 3 Introductory certificate (orange ribbon)*Please selectYesNoHave you successfully achieved the Handstrip Unit*Please selectYesNoCity & Guilds Registration Number* At which Centre and on what date will you be taking the exam?* Unit No to be completed*Please Select19 - Spaniel19 - Spaniel & 20 - Short Leg Terrier19 - Spaniel & 21 - Poodle19 - Spaniel & 22 - Long Leg Terrier20 - Short Leg Terrier20 - Short Leg Terrier & 21 Poodle20 - Short Leg Terrier & 22 - Long Leg Terrier21 - Poodle22 - Long Leg Terrier inc Schnauzer19 - Spaniel, 20 - S.L.Terrier & 22 - L.L.Terrier19 - Spaniel, 20 - S.L.Terrier & 21 - PoodleCost per dog is £140 to be paid to Summit Groomer Training Group. This covers examination and invigilator costs only. Along with the application for the third and final dog, a further amount of £45 for certification must be paid. CERTIFICATES WILL NOT BE CLAIMED UNLESS THIS PAYMENT HAS BEEN RECEIVED. ALL FEES CHARGED ARE NON REFUNDABLEAmount Paid*Please indicate payment method* Paid direct into Summit GTG account: Sort Code- 20-78-42 Account – 93200817 Paid by card to Summit GTG on: Telephone No - 01535 661776 Candidate Signature*Date* DD slash MM slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.