SURNAME :

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NAME :

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POSTAL ADDRESS :

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SUBURB :

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POSTAL CODE :

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TELEPHONE : HOME  :

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WORK  :

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CELL :

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E-MAIL :

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DO YOU WANT FREE CHILD CARE FACILITIES ?

YES   NO

DO YOU WISH TO APPLY FOR A BURSARY ?

YES   NO

I WISH TO REGISTER FOR THE FOLLOWING COURSES :

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PLEASE INDICATE WHERE YOU HEARD ABOUT OUR PROGRAMME:

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TOTAL FEES DUE :

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PAYMENT METHOD :

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Cheques or postal orders should be made out to St Joseph’s Adult Education Programme

Please print this form.    

Registration and payment by hand can be delivered to St Joseph's school and left with reception

(Mon - Fri 8.30am - 3.30pm)

Banking Details:
St Joseph's Adult Education Programme
Current Account
Nedbank, Rondebosch
Branch code: 104809
Account no: 1048 03 22 56
Please fax the confirmation slip to 021 686-9295