Membership

Alliance Française Côte du Nord

Membership Application Form

Your Name(*)

Please let us know your name.

Address(*)

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Please fill in your address here

Telephone(*)

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Secondary telephone

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Country of Origin

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Alliance Class

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If you are a current student please
state which class you are enrolled in.

Your Email(*)

Please let us know your email address.

I would like to receive information by Email.

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Photo Permission

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

Membership

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Select Membership type above
Memberships are due in January each year

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
or
Cheque - payable to "Alliance Française Côte du Nord Inc"
PO Box 6061, South Lismore NSW 2480

Message

Please let us know your message.

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