PLANET EARTH EDUCATION
For Astronomy and Environment

The Nature of the Stars 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              Payment in Full                     £ 70      £120 

    

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 :

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