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| This form should be printed, completed and signed by the person who bought SamAtHome. Then, place it in an envelope and post it to: |
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| |
| To, |
| Warranty Details |
| SAM Learning Ltd. |
| The Forum |
| 74/80 Camden Street |
| London |
| NW1 0EG |
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| SamatHome subscriber: |
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| .................................... |
| Name as it appears on their credit card |
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Name of GCSE Student (if different from above):
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| .................................. |
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| Month and Year in which GCSEs are being taken |
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| Month ........... Year ............ |
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| Name and address of school/college where the student is studying: |
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| School/College ................................ |
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| Address ................................... |
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| .................. Post Code ....... |
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| Name of the teacher/tutor for each GCSE subject: |
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| Maths teacher/tutor |
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| Title (Mr/Mrs/Miss) ..... Initials ....... Surname ....... |
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| English teacher/tutor |
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| Title (Mr/Mrs/Miss) ..... Initials ....... Surname ....... |
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| Science teacher/tutor |
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| Title (Mr/Mrs/Miss) ..... Initials ....... Surname ....... |
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| I agree to be bound by the Terms & Conditions of this offer. |
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| Signature of Subscriber .................. |
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| Print Your Name .................. |
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| Date .................. |
