Enrolment Form

Given Name(*)

Please let us know your name.

Surname(*)

Invalid Input

Postal Address(*)

Invalid Input

Town(*)

Invalid Input

Postcode(*)

Invalid Input

Phone(*)

Invalid Input

Secondary Phone

Invalid Input

Child's Date of Birth

/ / Invalid Input

NB: Required for French Role Play for Kids enrolments only.

Your Email(*)

Please let us know your email address.

New or Continuing(*)

Invalid Input

Class Selected(*)

Invalid Input

'Early Bird' Fees(*)

Invalid Input

Term 2 Courses: Pay by 18th July 2019
To become a member & be eligible for the lower fee, please refer to the "AFCDN student membership" dropdown menu below.

AFCDN student membership(*)

Invalid Input

NB: Adult students only. Membership is not required for HSC French Speaking Practice or 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(*)

Invalid Input

Textbooks not required for children's classes or Holiday Intensive French for Adults.
Books can be purchased in app form for iPad or tablet.

Total $(*)

Invalid Input

Payment Method(*)

Invalid Input

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(*)

Yes Invalid Input

I have read the terms and conditions

How did you hear about this class?

Invalid Input

Photo Permission(*)

yesno Invalid Input

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

Questions or Comments

Please let us know your message.

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

(*)

Invalid Input

Alliance Française Côte du Nord

Upcoming Events

Learn French

Local Radio

French radio programmes