Course enrolment

Enrolment Application Form

U3A Okeover Term 2, 2022 Courses


Please hand your enrolment form to the treasurer at the desk.

Your Name(s):

You can use this form to enrol one or two members.

Enter member name(s):
Member 1
Member 2

 

Select Your Courses...

The cost is $20.00 per course.

A: Thursdays 26 May 2022 to 23 Jun 2022

A: Making Christchurch a National Park City (NPC)

Followed by...

B: Thursdays 30 Jun 2022 to 28 Jul 2022

B: History

Additional Items

Annual Membership ($25.00 )

Payment

Total Due
__________

Payment Method

Via Internet or Phone banking into account No 03-1594-0108506-00 (Please ensure you enter a surname and initial)

Questions/Comments:


Your Contact Details

Please provide your contact details, so that we can contact you in relation to this enrolment application:

Name:

Email:

Complete these details only if they have changed:

Address:


Post Code:


Phone:

Emergency Contact:

Emergency Phone:

Signature: