HIRJI ASSOCIATES - Mentoring,Consulting & Coaching in Optometry

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 Individual Tutorial Application

              making optometric students more successful

Endorsed & Recommended by........ 

 

Name ...................................................................................................................................................

Address................................................................................................................................................

Tel (H)...............................................Tel(W)........................................Tel(M)....................................

e-mail...................................................................................................................................................

Resits/Exams Scheduled  at: UMIST/Cardiff/City/Bradford/Aston/Anglia/Glasgow Please Indicate

Date(s).....................................................................................................................

Subject(s) and Payment:

You may use PayPal to pay fees by Credit or Debit Cards   VisaMastercardPayPal CreditCardAmerican ExpressSwitchSoloVisa DeltaVisa Electron

CDM (1day) Tutorial 1     £945.00 inc VAT by

  

or cheque enclosed (preferred method)

Contact Lenses (1 day) Tutorial 2     £945.00 inc VAT by

or cheque enclosed
(preferred method)

Ocular Disease and Abnormality(1 day) Tutorial 3     £945.00 inc VAT by

 

or cheque enclosed
(preferred method)

Routine Examination(1/2 day) Tutorial 4     £472.50 inc VAT by

or cheque enclosed
(preferred method)

Please tick to indicate.
I understand that all tutorials are booked on a "first come first served" basis, that attendance at the tutorials does not guarantee success in the Final Assessment  and that HIRJI Associates reserve the right to cancel these tutorials in part or in total.

 

 

Signed------------------------------------------------------------Date--------------------------------

 

If paying by cheque (preferred method) please make cheque payable to "N K Hirji",

Whether you pay by PayPal or Cheque you must print and post this application form
duly completed (with cheque(s) if not paying by PayPal) to: 
HIRJI Associates, 7 Milford Rd, Harborne, Birmingham 
B17 9RL, UK

We will subsequently contact you to arrange the details.