Irish Summer Course Form – Columbus Club

Foirm Iarratais/Booking Form 2017

Cúrsaí/Courses

Tuesday, 6th June – Friday, 16th June
Monday, 10th July – Friday, 21st July
Monday, 7th August – Friday, 18th August

€350 don dá sheachtain/€350 for 2 weeks:

Ainm an Dalta/Student’s Name:

Seoladh/Address:

Buachaill/Boy

Cailín/Girl:

Data Breithe/Date of Birth:

Ainm Scoile/School Name:

Rang nó Bliain/Class or Year:

Fón Póca/Mobile Phone:

Rphost teagmhála Tuismitheora/Chaomhnóra/
Parent/Guardian Contact Email:

Seolfaidh muid riomhphost duit le deimhniú (confirmation sent by email)

Tinneas, Bail leighis, alléirgí nó deacrachtaí foghlamtha/
Medical conditions, medications, allergies or learning difficulties.

Siniu an Tuismitheora/
Parent’s Signature:

Airgead Seiceálacha – Ba cheart seiceanna a
dhéanamh iníoctha le Anne Ruane/(Payment is accepted by cash/cheque and bank details. Please click here for – cheques should be made payable to Anne Ruane)

Account Name: Anne Ruane Columbus Club
Account Number: 00597297
National Sort Code: 93-12-92
IBAN: IE69 AIBK 9312 9200 5972 97
BIC: AIBKIE2D
Bank: AIB Ranelagh, 40/42 Ranelagh, D6.

Iarrtar ort an foirm iarratais agus an táille a
sheoladh ar aghaidh faoi chúram-:Please return completed booking form and fee to the address given below:
or you can submit your registration online and pay via the bank details above.

Anne Ruane, Columbus Club, 30 Lower Lesson Street, Dublin 2.Tel:Anne 087-416 7740 Email:anne@columbusclub.ie Web:www.columbusclub.ie