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Enrolment Form -

Enrolment Form - Please Print this form (by clicking the printer friendly option on the top of this page ) and fill out by hand.

Name
	Last:	First:	Middle:

Gender
Male:		Female:

Mailing Address:

Telephone Number:

Date of Birth:

College currently being attended:
G.P.A
Major/Level of current studies:
Area/Topics of Special Interest:
Specify your choice of programmes/courses:

Specify Your Accommodation:
Family Guesthouse		Student Residences With BreakfastNo Breakfast

I require single room accommodation (supplementary charge)
I enclose a preliminary booking deposit of €250
I enclose an accommodation deposit of €125
Payment should be made by International Bankers Draft or Money Order (drawn on a bank)

Further information from and return application form to:
Seamus O'Grady,
Summer School Office,
National University of Ireland, Galway,
Ireland

The application form can be faxed or posted.

Telephone: 353 91 750304
Fax: 353 91 525051

Summer School Office, National University of Ireland, Galway, University Road, Galway, Ireland.
Phone: +353 (0)91 750304, Fax: +353 (0) 91 525051
E-mail: fiona.dwyer

nuigalway.ie
This page was last updated Tuesday, June 01, 2010