ࡱ> 584 bjbjWW .55 ****F*$ZZZZZQ"Q"Q";$=$=$=$=$=$=$$%f(a$Q"#.Q"Q"Q"a$ZZ v$###Q""ZZ;$#Q";$###Z0¸Hs"F#'$$0$#&)"B&)#&)#,Q"Q"#Q"Q"Q"Q"Q"a$a$#Q"Q"Q"$Q"Q"Q"Q"&)Q"Q"Q"Q"Q"Q"Q"Q"Q" : Short Course in Spatial Veterinary Epidemiology For University Use Only REGISTRATION AS A SHORT COURSE STUDENT Please complete in full and tick ( ) the boxes as appropriate  FULL NAME Date of Please write your full name in the same way as you would like it to appear on any correspondence with us and underline your surname/family name TITLE (Mr, Miss, Mrs, Dr, other) SEX MALE FEMALE ADDRESS  COUNTRY POST CODE/ZIP CODE TELEPHONE NUMBER (WORK) (HOME) Fax Number (work) (home) Qualification: EMAIL ADDRESS I am registering as a Short Course Student for the: Fee Paid: V 70: Investigation of Spatial Patterns of Animal Disease (600)  V35-1: Geographic Information Systems in the Spatial Analysis of Animal Diseases (310) V35-2: Exploring and Modelling of Spatial Data in Veterinary Epidemiology (310) Date: I am enclosing payment of with this form. My sponsor will be paying my fee direct to the University. Their name and address (including contact) is:  My sponsor will require an invoice before payment can be made: Please make cheques Payable in Sterling to The app  Memorandum of Agreement This Memorandum of Agreement is governed by and shall be constructed in accordance with, English Law and the parties hereby submit to the jurisdiction of the English Courts for all purposes relating to this Memorandum of Agreement. I hereby accept responsibility for obtaining any government clearance or permission that may be necessary for me to undertake these studies. I agree to comply with the regulations, as well as the procedures, deadlines and instructions issued by the University. I agree to the University of London processing my personal data contained in this form and other personal data, which the University from me or other people connected with my studies. I agree to the processing, retention and disclosure for normal academic and administrative purposes in accordance with the principles set out in the 1998 Data Protection Act. I agree that: (i) the University may commence the supply of educational services to me immediately on its acceptance of my registration as a Short Course Student; and (ii) I shall have no right to cancel this Agreement without consent of the University (and this consent will only be given in the most exceptional circumstances). Students signature Date  6DMUW~ # ' 1 4 F G b x y z | ൣڗڗڗڗڗڗڗڗڗyڗڣ h6QCJ hktCJ"jh6QCJUmHnHsH u h6QCJ h+YCJ"jh+YCJUmHnHsH uh+Y5CJ\$jh+Y5U\mHnHsH uh+Y5CJ\ h+YCJh+Y h+Y5\(jh+Y5CJU\mHnHsH u/W~b y ! 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