Enrolment Form

Given Name(*)

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Surname(*)

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Postal Address(*)

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Town(*)

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Postcode(*)

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Phone(*)

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Secondary Phone

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Child's Date of Birth

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NB: Required for Kids' French in Action enrolments only.

Your Email(*)

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New or Continuing(*)

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Class Selected(*)

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'Early Bird' Fees(*)

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Term 4 Courses: Pay by 4th October 2018
To become a member & be eligible for the lower fee, please refer to the "AFCDN student membership" dropdown menu below.

AFCDN student membership(*)

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NB: Adult students only. Membership is not required for children's classes.
AFCDN Membership is compulsory for all adult students and needs to be renewed yearly (in January). Please contact us if you are unsure of your current membership status.

Alter Ego Plus books(*)

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Textbooks not required for children's classes.
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(*)

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

Questions or Comments

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In the box above, please note any questions, comments or further information, e.g., for Kids' French in Action students - age(s) of child(ren), school level, names of parent(s), etc. :-)

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