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    Enrolment form
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Code No. Class Name:   Cost: $
Code No. Class Name:   Cost: $
Code No. Class Name:   Cost: $
Code No. Class Name:   Cost: $
Please make a note of the total cost. We will confirm the total amount outstanding in our confirmation email. Please confirm that you intend paying by Direct Credit   Y      N   Total: $
     
Last name:*  
First names:*  
Addresss:*  
Home Phone No.  
Work Phone No.  
Email Address:*  
     
Ethnic Group:*

Please choose from below
Maori
NZ European/Pakeha
Asian
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Other

 

Age Group:*  
I wish to pay by Direct Credit

ANZ Bank Masterton

No 01-0682-0200279-08

Please ensure that your name and the

name of class enrolled in is included on banking ref.

 

 

       
 

 

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