PLANET EARTH EDUCATION
For Astronomy and Environment

GCSE 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              Payment in Full                      150      180 

        (please tick box)              First of two instalments            76         92 

                                                 First of four instalments        39        47 

                                                 First of eight instalments       20         24 

Please include your first payment with your enrolment.

Please make cheques and postal orders payable to Planet Earth Education

9.    Signature   

10.    Date          

11.    E-mail address 

Please forward Enrolment form and Remittance to :

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