FLYING COLOURS IMAGE SCHOOL

                     ENROLMENT APPLICATION


Flying Colours Image School,
84a Stranmillis Road,
Belfast,
BT9 5AD,

Tel/Fax: 028 9038 1919

e-mail: evelyn@susanrainey.com


Surname ____________________ First Name _______________________

Home Address __________________________________________________
             __________________________________________________

Telephone _____________________________________________________

Date of Birth ________________    Marital Status ______________

Present Occupation ____________________________________________

Educational and Career Background _____________________________
             __________________________________________________
             __________________________________________________
             __________________________________________________

Please reserve a place for me on the Colour Analysis / Image 
for Women Training Programme:

Preferred Dates _______________________________________________

I enclose ___________________________ as Deposit / Full payment

    (A deposit of no less than £100 will be accepted - 
     Balance to be paid on the second day of the course)

Cheques to be crossed and made payable to Evelyn Burns

Signed _________________________ Date _________________________

Please add any further information which you consider would
support this application.