100 club plus membership form

August 16th, 2016

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Student's name*
First Last
Select Year Level*
My child is a*
- Current student
- New student
Parent's name*
First Last
Parent's mobile*
Parent's email*
Centre you'd like to attend*
Preferred Appointment Date
Preferred Appointment Time

: Hours

Minutes

AM/PM

Note: Only available 11am - 7.30pm Mon - Fri, 9am - 7.30pm Weekends. Bookings MUST be confirmed by phone or SMS prior to appointment date.
Any specific requirements?
e.g. language (English, Chinese, Korean), enrolment / subject specific
Phone
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