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MOUNT ALBERT GRAMMAR SCHOOL
ALBERTON AVE
MT ALBERT

NAME: ..........................................................................................

ADDRESS.......................................................................................

Postal Code.
TELEPHONE:

(Home)...................................... (Bus.).....................................

E-MAIL ADDRESS: ..........................................................................

FEE ENCLOSED $................................................

COURSE ..........................................................................

DAY(S) ..........................................................................

PLEASE NOTE: NO REFUNDS UNLESS CLASS FAILS TO START.
Your receipt will be issued by your tutor on the first night of class.

The following statistics are requested and used by the Ministry of Education only:

Please circle:

Male Female

Age: 16-19     20-29     30-39     40-49     50-59     60+

European/Pakeha Maori Pacific Islander

Asian Other

PLEASE MAKE CHEQUES PAYABLE TO MOUNT ALBERT GRAMMAR SCHOOL
Credit Card facilities available on-site or by phone