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(*)

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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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'Early Bird' Fees(*)

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Term 1 Courses: Pay by 22nd January 2021

AFCDN student membership(*)

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AFCDN Membership is compulsory for all 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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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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