POSTGRADUATE DIPLOMA IN BENESH MOVEMENT NOTATORS (PGDBMN) Application Form Please write or type in black ink in English using BLOCK CAPITALS for sections 1-3 Return this form to Benesh International, Royal Academy of Dance, 36 Battersea Square, London SW11 3RA 1 START DATE I wish to enter the programme in (please give month and year, and indicate whether approximate or definite dates) 2 YOUR CONTACT DETAILS Title (Mr, Mrs, Miss, etc) First/Given Name(s) Address Surname/Family Name Country Home Tel: Fax: Mobile Tel: E-mail: 3 OTHER DETAILS Date of Birth (DD/MM/YYYY) Nationality What is your first language? Age at start of programme Country of permanent residence Do you speak any other languages? If successful, how do you intend to finance your studies?
4 Please state your NOTATION EDUCATION & QUALIFICATIONS 5 Please summarise your DANCE EDUCATION & QUALIFICATIONS 6 Please describe RELEVANT EMPLOYMENT, WORK/DANCE EXPERIENCE ETC 2
7 PERSONAL STATEMENT: WHAT ARE YOUR REASONS FOR APPLYING FOR THIS PROGRAMME? 3
8 GIVE DETAILS BELOW OF ANY SPECIAL NEEDS OR SUPPORT REQUIRED DUE TO A DISABILITY OR MEDICAL CONDITION Data Protection Statement: Benesh International at the Royal Academy of Dance is committed to protecting and respecting your privacy. How do we collect information from you? Data such as your name, address, email, telephone number, bank account or payment card details will be collected via an online or manual paper application form, or through a telephone conversation in response to your specific request to be enrolled or registered in any of our courses, programmes, events and/or included in our general contact database. In the case where payment is required, details will be circulated to the RAD Finance team. Your choices and individual privacy rights You have a choice about whether or not you wish to receive information from us. If you give permission to receive communications about the work of the Royal Academy of Dance and our products, services and events, you can select your choices by ticking the relevant boxes on any Benesh International application forms for our various courses or contact us directly at beneshinternational@rad.org.uk. You can change your preferences, withdraw your consent, object or ask for processing to be restricted at any time by emailing us at beneshinternational@rad.org.uk or tel +44 (0) 20 7326 8035 or writing to Benesh International, 36 Battersea Square, London SW11 3RA Corporate Privacy Notice For further information and for details on how your information is used, please read the Corporate Royal Academy of Dance Privacy Notice at: www.royalacademyofdance.org/privacy-notice Declaration: I confirm that the information given on this form is true, complete and accurate and no information requested or other material information has been omitted. I agree that if I am admitted to a programme of study at the Royal Academy of Dance, I shall abide by the Regulations of the Academy. I have read the statement on Data protection and agree to the use of my personal data as outlined and the RAD s rules and policies on the use of personal data. Applicant s signature Date: Please return this form with the non-refundable Registration Fee to Benesh International, Royal Academy of Dance, 36 Battersea Square, London SW11 3RA. 4
PGDBMN Registration fee payment: Pay by: Bank Transfer (See details below) or pay by Credit/Debit card via phone : +44 (0) 207 326 8018 or: Cheque ( pound sterling only) : Please make out to the Royal Academy of Dance. I agree to abide by the Academy s general terms and conditions: If you are sending your application form by email, please select this box and type your name as a substitute for your signature. Signature: Date: If you wish to pay by bank transfer, please follow the guidelines below: All charges must be borne by the transferor. When submitting your application, please attach a copy of the bank transfer confirmation to help us to match up the payments. Please ensure that your name (not the name of the transferor (if different from yours) and name of the course (PGDBMN) is given to the bank to ensure we can identify the payment. Failure to do so can result in your payment remaining unidentified and your fees considered being outstanding. Bank details Bank Name: HSBC Bank Plc Bank Branch: Holborn Circus Bank Address: 31 Holborn Circus, London, EC1N 2HR Account Name: Royal Academy of Dance For sterling transfers Bank Account No: 90055948 Sort Code: 401158 Swift Code: HBUKGB4194P IBAN: GB48HBUK40115890055948 For Euro transfers Swift Code: MIDLGB22 (HSBC Bank Plc) IBAN: GB03MIDL40051557596782 General Terms and Conditions 1. All applications and payments will be processed in order of receipt. 2. We will contact you primarily by email. If the email address on the application form is unclear, incorrect or illegible, the RAD incorporating the Benesh Institute cannot be held responsible for missed or misdirected email communications. 3. Applications are non-transferable. 4. The Academy does not normally provide receipts unless requested to do so. An alternative is to retain a copy of your application and match it with your credit card slip / bank statement as evidence for your accountants. 5. The Academy reserves the right to alter the advertised programme without prior notice. The information in this and other printed or electronic brochures/notices is correct at the time of print or going online. 6. The RAD reserves the right to amend the Application Form and these Terms and Conditions. Royal Academy of Dance is a charity registered in England and Wales no 312826. 5