Contact

Information Request Form

*Denotes required field

Title:	please select your title
*First Name	first name
*Surname	surname
*Address Line 1	address line 1
*Address Line 2	address line 2
Address Line 3	address line 3
Address Line 4	address line 4
Address Line 5	address line 5
*Postcode	postcode
*Telephone	telephone
*Email Address	email
Date of birth if under 19 years old	date of birth if under 19 years old
*Your request	your request
Where did you hear about LZ6?
	Prospectus
	Open Day/Event
	Careers Advisor
	Newspaper
	Family/Friends
	Local Radio
	Visited the Learning Zone
	This website
	Connexions Advisor
	Poster or banner
	Letter
	Through my Employer
	Exhibitions or careers convention
LZ6/Macclesfield College would like to contact you from time to time about the range of courses it has available and forthcoming events. If you wish to receive any promotional literature of this nature, please check this box. Data Protection Act 1998 In completing and submitting this form I accept that LZ6/Macclesfield College will store, on electronic media, the information on this form.
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