NAME:

ADDRESS:

DATE OF BIRTH:

CONTACT NUMBER: (W)
                                   (H)
MOBILE:

FAX NUMBER:

EMAIL:

A. PLEASE CIRCLE ONE OF THE FOLLOWING:

1. THE WRITE VOICE: The cost of the course is R1 800,00 payable in three easy instalments: R600 deposit to register and start Units 1 - 4; R600 for units 5 - 8; and R600 for units 9 - 12
SPECIAL DISCOUNT: If settling the full amount of R1 800 (One Thousand Eight Hundred Rand) in one payment, there is a discounted rate of R1 500 (One Thousand Five Hundred Rand).

2. THE WRITE JOURNEY:  If paying the full amount of R1 800 (One Thousand Eight Hundred Rand), there is a discounted rate of R1 500 (One Thousand Five Hundred Rand). If down-paying: a deposit of R600 that includes Units 1 - 4; R600 for Units 5 - 8; R600 for units 9 - 12. 

3. THE WRITE DRAFT:  If paying the full amount of R1 800 (One Thousand Eight Hundred Rand), there is a discounted rate of R1 500 (One Thousand Five Hundred Rand). If down-paying: a deposit of R600 that includes Units 1 - 4; R600 for Units 5 - 8; R600 for units 9 - 12. 

* The cost excludes reading and evaluation of scripts, manuscripts, or further one-on-one sessions.

B. DEPOSIT THE REQUIRED AMOUNT INTO THE ACCOUNT:
Account name: D.E.Dercksen (Sole Proprietor trading as The Writing Studio)
Standard Bank - Kromboom Branch
(Branch code 026209)
Savings Account number: 27 550 5618

TAX NUMBER: 061 708 2151

C. PRINT, THEN FAX SIGN UP FORM  AND DEPOSIT SLIP TO: 

08 66 721 757

SIGNATURE OF PERSON RESPONSIBLE FOR FEES

NAME (typed or printed)

DATE:

ACCEPTED AND AGREED TO BY GUARDIAN OR PARENT IF UNDER THE AGE OF 18

SIGNATURE'

NAME (typed or printed)

Dated: