Enrolment Form

Please refer to course information on this page, and contact us if you wish to enrol.

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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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).

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(*)

Yes

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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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In the box above, please note any questions, comments or further information.

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Alliance Française Côte du Nord

Enrolment Form

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