Enrolment Form



Prior to enroling in our courses, please read our Enrolment Procedure by clicking here.



Surname: First Name:
Home Address:
Home Phone No: Work Phone No:
Sex: M F Age: 16-19 20-29 30-39 40-49 50-59 60+
Ethnic Descent: Asian Maori Pacific Island None of  these
Code No Course Title Fee
Permanent NZ resident?
YesNo
Payment: Cash Cheque Mastercard Bankcard Visa
Credit card number:
Card holders name: Expiry date:


PLEASE ONLY SUBMIT THIS FORM IF PAYING BY
VISA, MASTERCARD OR BANKCARD