BCDM Module Payment Form for Groups
Welcome to the module payment form for groups of three or more from the same parish. Please answer the questions as accurately as possible.
start
 
Which module have you registered for?


 
First name

 
Surname

 
Groups of three or more from the same parish receive a 20% discount on the normal price of £25 per module.  Please use the questions below to make a payment of £20.  Thank you. *

If you are unable to pay online, please bring a cheque made payable to Coventry DBF or cash to the first session.
 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


 
Thank you for completing your payment.  We look forward to seeing you at the module.
Please select 'Submit' below.

Thank you.