Advanced Astronomy Enrolment Form

1.    Title        2.   Full Name    

3.    Date of Birth        4.    Gender    Male        Female   

5.    Address   

6.    Telephone Number   

7.    Usual Occupation      

                                                                                                UK         Overseas

8.    Amount Enclosed                                 Section 1              £60           £80

                                                                 Section 2               £60           £80

                                                                 Section 3               £60           £80

                                                                 Section 4               £60           £80

                                                                        Total Enclosed     £          

Please include your payment with your enrolment.

Please make cheques and postal orders payable to Planet Earth

9.    Signature   

10.    Date          

11.    E-mail address 

Please forward Enrolment form and Remittance to :

Planet Earth,  45 willow Avenue, Middleton, Manchester, M24 2HE.