Application For Membership of Computer Pals for Seniors

Do not open this form in designer. Will corrupt form
MEMBERSHIP APPLICATION
Note: Fields marked with an asterisk ( * ) must be completed.
Tick Appropriate box:*

Being aged over 55 and retired or semi-retired (Qualified), I hereby apply to become a member of the Club.Not being Qualified, I hereby apply for exercise of the Committee's discretion under the Constitution to become a member of the Club.
FIRST NAME:*
SURNAME:*
ADDRESS:*
EMAIL ADDRESS:*
POST CODE:*
MOBILE:
HOME PHONE:
MEMBERSHIP AND TUITION PAYMENT
Joining Fee:
Annual Subscription: $30 per calendar year

Full year
Pro-rated

January - June $15July - December $15
Subscription Fee
Individual Lessons : $15 per lesson

1 Lesson2 Lessons3 Lessons4 Lessons5 lessons for $60
Individual Lesson fee:
TOTAL FEES
Pre-payment required - select payment method.*

(EFT) (see below for account details)Cash (bring to first lesson - in envelope with name and amount please)
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 ?

DESKTOPLAPTOPTABLETSMART PHONE
Please choose:

IPHONEANDROID PHONE
Type of computer ?

APPLE / MACPC / WINDOWS
Describe the training you would require ?
TERMS & AGREEMENT*

In the event of my admission as a member, I agree to be bound by the Constitution of the Club for the time being in force.
Reply to email
Senders Name
Should be Empty:

MEMBERSHIP APPLICATION