West Auckland Parents Centre

Course Code *

Please check the course code is correct (refer to website)
Name * First Last
Partner/Support Person Name (if attending) First Last
Contact Number *
Email *
Ages of Children *

Seperate ages by comma. eg 1,3,5
Current member of West Auckland Parents Centre *
Yes No
How did you hear about West Auckland Parents Centre *
LMC Posters/Flyers Word of Mouth Internet Other
How would you like to pay? *
Bank Transfer Credit Card (incurs additional processing fee, ~3%)
Privacy

The information collected on this form will only be used for the purposes of course evaluation, membership records or in the collection of PCNZ statistics, in which you will not be identified
Do Not Fill This Out