HomeMy WebLinkAboutThe Wingham Advance-Times, 1985-03-13, Page 84Application/Registration Form
Please print all Information
Return forrn to the Campus offering the course. We would
appreciate; a .5uparate cheque for each course'.
CONTINUING EDUCATION - APPLICATION/REGISTRATION FORM
Carr p',�
Course:
Specify your choice of time slot it Day' Starts:
more than one class is advertised on
the same day
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Col
nology
NOTE: THIS IS NOT A RECEIPT.
Name
Address
No and Street
CityPostal
-Residence
Code Telephone,
Employer Business
' 4' Telephone
Are you currently reoistered through the Registrar's Office in a full-tirrtl'e day program at Conestoga College?
Yes o°
If YES to above, pl'ease enter your Student I.D. # �^
Please check one o;f he following:
(a) I am under 19 and have successfully. completed Grade 12 or,
(b) I am under 19 and have not successfully completed Grade 12 or,
(c) I am a Senior Citizen (Age 60 and over) C 1 or,
(d) I am over 19, but not a senior citizen I
How Did You'Find Out About Conestoga College Continuing Education Courses:
Radio Friend- 1
Newspaper .
Other
Last Name
Apt No.
ie r
Fest Name
Sex Male
Female ! !
(Please specify) Catalogue
Cheque or Money
Order enclosed for $ (full course fee) payable to Conestoga College.'
We do not accept post-dated cheques.
Registration is limited to Canadian Citizens and/or Permanent Residents unless specfahpermession has been granted by Employment and Immigration
Canada You may apply tor a refund before the start of the third scheduled class For additional information please refer to the Refund section in the front
of the catalogue We do not accept registrations or reserve spaces over the telephone It is the responsibility of each student to be enrolled in a Health
Insurance Plan or OHIP
Applicant's Signature:
CAMPUSES
Cambridge Campus
1305 Bishop Street N.
Cambridge, Ontario.
N11:4 6Z2 '
(519) 623-4898
Doon Campus
299 Doon Valley Dr,
Kitchener, Ontario.
N2G 4M4
(519) 653-7460
Note: Applications must be signed and dated.
Clinton Campus,
Vanastra Rd:
P.O. Box 16I
Clinton, Ontario.
NOM 1L0
(5°19) 48273458
Stratford. Campus
' 270 Water Street
P.O. Box 848
Stratford, Ontario.
N5A 6W3
(519) 271-5700 .
_Date:
Form R08a
Guelph Campus
460 Speedvale Ave. W.
Guelph, Ontario,.
N1H-6N6
(519) 824-9390
Waterloo Campus
435 King Street N.
Waterloo, Ontario.
N2J 2Z5
(51,9) 885-0300
11 mere is a rnaiI interruption please take your Apphcation Re9 st �. ration Form to the campus Oftenng tie course
REGISTER EARLY! DON'T BE DISAPPOINTED! CLASS SIZE
'1 - S ARE LIMITED!