Ace 16 Squads Registration Form

Ace 16 Squads

Registration Form - 2016
Student Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Gender *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Mobile Number *

Area Code Phone Number
Phone Number

Area Code Phone Number
Ace 16 Squads *
Additional Comments
Fees for Term 3:

For CLTC Members - $225

For Non Members - $250
Pay by Electronic Transfer

Account Holder: Andre Vaz Pinto

BSB: 124 001

Account Number: 218 406 98
Should be Empty: