Ace 16 Squads Registration Form

Ace 16 Squads

Registration Form - 2016
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Mobile Number*

Area CodePhone Number
Phone Number

Area CodePhone 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: