Enrolment Form

Given Name(*)

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Surname(*)

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Postal Address(*)

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Town(*)

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Phone(*)

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Secondary Phone

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Your Email(*)

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New or Continuing(*)

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Class Selected(*)

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Course Fees(*)

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AFCDN student membership(*)

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AFCDN Membership is compulsory for all students and needs to be renewed yearly (in January). If you were enrolled in a Term One, Two or Three 2022 class, your membership is current. For all new students, membership is required. Please contact us if you are unsure of your current membership status.

Alter Ego Plus books(*)

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Books can be purchased in app form for iPad or tablet.

Total $(*)

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Payment Method(*)

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Direct Deposit
NAB - Molesworth St, Lismore
Acc Name: Alliance Française Côte du Nord Inc
BSB: 082-707
Acc No: 21 839 2289
* Remember to include your name & a description of your payment
or
Cheque - payable to "Alliance Française Côte du Nord Inc"
PO Box 6061, South Lismore NSW 2480

Terms & Conditions(*)

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I have read the terms and conditions

How did you hear about this class?(*)

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Photo Permission(*)

yesno

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I give permission for photos of myself
to appear on the website

Questions or Comments

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