ICC Music and Literature Class Registration 2019
Check Website for course dates.

Privacy: Your data will not be shared with any external agencies and will be seen only by staff and tutors of the Irish Cultural Centre Hammersmith.
Email address *
Name: *
Your answer
What class would you like to register for? *
Address:
Your answer
Date of Birth (dd/mm/yyyy):
Your answer
Telephone Number: *
Your answer
Occupation:
Your answer
Is this your first time participating in the Irish Cultural Centre Education Programme?
If you answered 'No' to the last question please tell us which class:
Your answer
Are you Irish Born?* *
*Not a requirement
Are you of Irish descent?* *
*Not a requirement
How did you hear about the centre?
Your answer
How would you like to pay? *
Paypal link will appear for everyone once submitted regardless of answer.
Do you accept the terms and conditions as stated below: *
Captionless Image
I confirm, by signing below, that I have read and accepted the terms and conditions of subscription and participation in the ICCH Ltd Education Programme* and all information given is up to date and correct. *
Please sign by typing name and date.
Captionless Image
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Irish Cultural Centre. Report Abuse