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Enrolment Form

How to Use this Form - to enrol on-line, please complete the form below and then click the "Send" button at the bottom of the page. Only send this form online if you are paying by Mastercard or Visa.

If you prefer to enrol by mail, print this form after completing it in your browser, or print the form as it is and complete it clearly, using a pen. If you aren't using a Mastercard or Visa, attach your cheque and.mail the completed form to:

PO Box 34-603, Birkenhead.
Please make cheques payable to Northcote College.
If you are electing to pay by credit card, please note the padlock symbol indicating this is a secure page. The padlock symbol can be found in the Security Status bar located on the right side of the Address bar at the top of the page:-

On older versions of MS Internet Explorer or alternative browsers (Mozilla Firefox, Google Chrome etc), this will appear at the foot of this page.


Thawte logoYour details on this page are encrypted and secured by our Thawte secure server software (using SSL technology). This is the industry standard and among the best software available for secure transactions. NOTE re CONFIDENTIALITY - All information is for the use of Northcote College Community Education only and will be kept confidential. Personal information will not be released or made available to any other party. Contact detail may be used by the College to communicate with you periodically in the future.

If not enrolling online, return to Enrolment Page
* indicates a required field
First Name
Surname *
Home Address
Home Phone * Work Phone
Email Address *
How Did You find This Website?
The Ministry of Education requests this information for statistical purposes:-
Sex M F Age 16-19 20-29 30-39 40-49 50-59 60+
Descent Asian Maori Pacific Island None of these
Code No Course Title Fee
Permanent NZ resident?
Yes No
*
 
Payment Cheque (Mailed Enrolments Only) Mastercard Visa
Credit card number
Card holders name Expiry date

Or, if not enrolling online, return to Enrolment Page