First name: *

Surname: *

Company:

C/O:

Address: *

Post code: *

City: *

Country: *

E-mail *:

Telephone *:

Mobile phone *:

Job title: *

Company expertise: *

Name of employer / Trading name: *

Employer: *

How many employees do you have within your company?: *

Industrial Sector, please chose one of the following: : *
TVRadioFilmMusicPublishingDigital & Creative ServicesGamesITExperience in the media
industry: *
Less than 3 months3 - 6months6 - 12 months 12 months - 2 years2 years - 3 years3 years - 5 years5 years - 8 years8 years - 15 years15 years plusLearning difficulties / Disability: *
NoYesWhat is your personal motivations to attend this course?: *

What is your strengths and weaknesses with regards to your current situation?: *

What is the age of your business?: *

What's your company turnover?: *

Date of birth (MM-DD-YYYY): *

What relevant educational experiences do you have?

What have you done the past three years?

What are your current work assignments?

Occupation:

Special diet needs:

How did you find us? *

The information supplied will be retained by NWV+M and will only be shared with partners and associated funders for the purpose of research, data analysis and administration. NWV+M and its partners directly or indirectly fund or part finance training and development initiatives using finance and support from Regional Development Agencies (NWDA), the European Social Fund, the UK Film Council, Skillset, and the Learning & Skills Council.
At no time will your personal information be passed to organisations for marketing or sales purposes. From time to time clients are approached to take part in surveys by mail and phone, which are aimed at enabling NWV+M and its partners to monitor performance, improve quality and plan future provision.

Tick box if you do not wish to be contacted directly by NWV+M or its partners in respect of surveys and research.
NWV+M welcomes publicity for the region, which sometimes involves the media filming or taking photographs of its clients and/or areas of interest. These photographs will be stored in a photo library by NWV+M partners. During this time they may be used by NWV+M and partners for media and marketing purposes, such as brochures, leaflets, posters and electronic forms of communication.

I give my permission for the photographs/film to be used for a minimum of five years, for the purposes of representing NWV+M and associated partners.
Yes No
N.B. This consent continues until you write to us to withdraw it.