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                                                         JMW Driver Training Centre
                  The Old Rectory, High Street, Caenby, Lincolnshire LN82EE Tel: 01673 878999
                                   Fax: 01673 878781              Email: sales@jmwtraining.co.uk
                                                               Proprietor: J Wood


                                                     D.G.S.A. APPLICATION FORM
 
PLEASE USE BLOCK CAPITALS

FULL NAME: ..……………………………………………………..........……...…......................…....

ADDRESS: .……………………………………………………………..........….....................…...……

COMPANY: ……………………………………………………………….................................……...

 ADDRESS: ……………………………………………………………...……..............................……
.
 …………………………………………………………...……………….…................................…...…
..
 
TEL: DAY ….……………..............…………. EVENING ..…………......…........…….......……..……
 
EMAIL: …………………………..............................................................................................................

 
DO YOU HOLD A CURRENT DGSA / ADR CERTIFICATE?        YES  /  NO

 If YES, for which classes? ………………………………......................…….....................…....……...

 ………………………………………………………………………………..................…….…….……

 
EXAMS TO BE TAKEN: (Please Tick)

 
            CORE MODULE                    …..…..

            ROAD MODULE                    ……....

            ALL CLASSES                     …….... 

 

Do you wish us to supply the required  publications?                 YES  /  NO

Do you wish us to book the exams on your behalf?                      YES  /  NO

 
AT WHICH CENTRE DO YOU WISH TO SIT THE EXAM? ……….................……..
 
I agree to the terms and conditions relating to this course, and that the information provided by me on this application form is correct
 

SIGNED………………..…..……..  POSITION …………..…..………. DATE …….……………..

Course Start Date:  1st Choice …….……....……….  2nd Choice ………..….…………

 Please return this application form to the above address, together with a £200.00 deposit to secure your place.

 
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