Course enrolment

Enrolment Application Form

U3A Okeover Term 3, 2021 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.

B: Thursdays 23 Sep 2021 to 21 Oct 2021

B: Diversity

Additional Items

Annual Membership

This fee is payable only once for the year.

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: