Please Click to Print This Page, complete and then email, fax, post or deliver this form. Close Window

Lake Nite Learning

UC Senior Secondary College Lake Ginninderra Phone: 6205 6665
Emu Bank Fax: 6205 7105
BELCONNEN ACT 2617 Email:classes@lakenitelearning.com.au

ENROLMENT FORM

Name:

Phone:

Home:

Work:

Email

Address:

P’code:

Course

Time

Fee

1

2

3

4

Credit Card Details (We accept BC/Visa/Mastercard)

Name on Card:

Card Number:

Signature:

Exp Date: