For Astronomy and Environment

PEC 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                      120      150 

        (please tick box)              First of two instalments            60         75 

                                                 First of four instalments        30        38 

                                                 First of eight instalments       15         19 

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.