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Application Form- GK Seminar Please complete the form fully in block capitals and return to the relevant regional office/Local authority office; you must complete all sections below to be accepted onto the course; these details are required in order to retain your qualification on the Scottish FA database. Full payment must also be received with this application for you to participate in this course. Title: Mr Mrs Miss Ms SFA ID Number (if known): Surname: Name: E-mail:(This is essential as all correspondence for this course is via email) Home telephone: Daytime telephone: Full address: Postcode:DOB: Club: Quality Mark Approved tick if applicable Please provide details of any medical conditions, disabilities, dietary requirements or specific needs: Course/Event Details CPD Event* Date of Event/Course: Venue: Cost: * If Event please give name of event: Cash: Cheque: Other: X X X Additional Candidates Name: Surname: E-mail: DOB: Name: Surname: E-mail: DOB: Name: Surname: E-mail: DOB: I have read and agreed with the Scottish FA’s terms and conditions in respect of Coach Education Signed: Date: Name: Surname: E-mail: DOB: Name: Surname: E-mail: DOB: Name: Surname: E-mail: DOB: Name: Surname: E-mail: DOB: Name: Surname: E-mail: DOB: