Registration for 3 Students

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5 Installments Payment Plan 2023- 2024 - 3 Students

PATENT(S) DETAILS

Family Name(*)

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Father's Name

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Mother's Name

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Email(*)

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Phone Number

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PLEASE PROVIDE DETAILS FOR THE FIRST STUDENT

Student First Name(*)

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Student Last Name(*)

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Student Gender

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Student Proficiency Level

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Student Date of Birth

/ / Invalid Input

Clan (If applicable)

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PLEASE PROVIDE DETAILS FOR THE SECOND STUDENT

Student 2 First Name(*)

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Student 2 Last Name(*)

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Student 2 Gender

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Student 2 Proficiency Level

BeginnerMediumGood Invalid Input

Student 2 Date of Birth

/ / Invalid Input

Clan

Invalid Input

PLEASE PROVIDE DETAILS FOR THE THIRD STUDENT

Student 3 First Name(*)

Invalid Input - Only letters and accented characters are allowed

Student 3 Last Name(*)

Invalid Input - Only letters and accented characters are allowed

Student 3 Gender

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Student 3 Proficiency Level

BeginnerMediumGood Invalid Input

Student 3 Birth Date

/ / Invalid Input

Student 3 Clan

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ADDRESS DETAILS

Address Line 1(*)

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Address Line 2

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City

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Zip Code/Postcode

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States

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Country

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PAYMENT DETAILS

Registration Fee: $150

Optional - Advance payment of installment:

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Total (Initial Payment)

$0.00 Invalid Input

Select Payment Method

PayPal

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Permission to Make recordings

We wish to take photographs and/or videos of participants in our events. These photographs and/or videos may feature your child. By ticking this box, you grant us permission to use the photographs and/or video in accordance with the terms of our Privacy Policy including in our printed publications, promotional materials, in the advertising of our services on our website and social media and to distribute to our sponsors, affiliates and partner companies to use for the same purposes. We will never release names alongside photos unless further permission is received via written contact with you Invalid Input

5 Installments Payment Plan 2023- 2024 - 3 Students

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