Membership Application Form

If you would like your membership retained /or would like to join us as a new member, please complete the form below. Memberships fall due at the beginning of May each year.

If you wish to send a printed form, please download and complete this pdf file and send your payment.

Membership Application Form

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Your Name(*)

Please let us know your name.

Address(*)

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Please fill in your address here

Telephone(*)

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Secondary telephone

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Country of Origin

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Alliance Class

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If you are a current student please
state which class you are enrolled in.

Your Email(*)

Please let us know your email address.

I would like to receive information by Email.

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Photo Permission

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I give permission for photos of myself
to appear on the website

Membership

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Select Membership type above
Memberships are due in January each year

Payment Method

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Direct Deposit
NAB - Molesworth St, Lismore
Acc Name: Alliance Française Côte du Nord Inc
BSB: 082-707
Acc No: 712939366
or
Cheque - payable to "Alliance Française Côte du Nord Inc"
PO Box 6061, South Lismore NSW 2480

Message

Please let us know your message.

Alliance Française Côte du Nord (NSW North Coast)

Membership Application Form

Membership Application Form

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