Application For Membership of Computer Pals for Seniors

Do not open this form in designer. Will corrupt form

Note: Fields marked with an asterisk ( * ) must be completed.

Tick Appropriate box:

FIRST NAME:

SURNAME:

ADDRESS:

EMAIL ADDRESS:

POST CODE:

MOBILE:

HOME PHONE:

MEMBERSHIP AND TUITION PAYMENT

Joining Fee:

Annual Subscription: $30 per calendar year

Pro-rated

Subscription Fee

Individual Lessons : $10 per lesson

Individual Lesson fee:

TOTAL FEES

Pre-payment required - select payment method.

Funds Transfer To: BSB: 633000 ACCOUNT: 189 796 592 or

PayID to cpskmem@gmail.com

Please reference your intitial and surname

Please tick relevant boxes below to help us allocate a tutor.

Computer/Device you would like to be trained on ?

Please choose:

Type of computer ?

Describe the training you would require ?

TERMS & AGREEMENT

Reply to email

Senders Name

MEMBERSHIP APPLICATION