Enrolment Form Please refer to course information on this page, and contact us if you wish to enrol. 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 Your Email(*) Please let us know your email address. New or Continuing(*) New StudentContinuing Student Invalid Input Class Selected(*) Please select a classMonday: Beginners Level 2 (online delivery)Tuesday: Beginners Level 5 (online delivery)Tuesday: Beginners Level 11 (online delivery)Wednesday: Advanced Level 1 (Lismore)Wednesday: Advanced Level 4 (online delivery)Thursday: Absolute Beginners (online delivery) Invalid Input 'Early Bird' Fees(*) Please choose Absolute Beginners, Beginners Levels 2 & 5: $165Beginners L11, Advanced Levels 1 & 4: $200 Invalid Input Term 2 Courses: Pay by 16th April 2021 AFCDN student membership(*) Yes: $10No Invalid Input AFCDN Membership is compulsory for all students and needs to be renewed yearly (in January). If you were enrolled in a Term One 2021 class, your membership would be current. Please contact us if you are unsure of your current membership status. Alter Ego Plus books(*) Yes: $60No Invalid Input Books can be purchased in app form for iPad or tablet. Total $(*) Invalid Input Payment Method(*) Direct DepositCheque 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?(*) Please chooseFacebookNewspaperFlyerFriendRadioWebsiteAF Film FestivalContinuing StudentOther 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. (*) Invalid Input