Clinton News-Record, 1984-01-04, Page 28opl_lcati'on /Registration Form
Please print all information
Return form to the Campus offering the course. We would
appreciate a separate cheque for each course.
CONTINUING EDUCATION - APPLICATION/REGISTRATION FORM—
Campus:
Course" Day:
Specify your choice of time slot if
more than one class is advertised on
the same day
Name:
NOTE: THIS IS NOT A RECEIPT.
Starts:
• Sex: Male 0
Female 0
' Last Name:
First Name
Address:
-Apt. No. •No.and Street
Postal Residence
City: Code: Telephone:
Business
Telephone.
Employer '
Please check one of the following:
(a) I am under 19 and have successfully completed Grade 12 ❑ or,
(b) I am under 19 and slave not successfully completed Grade 12.E or,
(c) I am a Senior Citizen (Age 60 and over) 0 or,
(d) I am over 19, but not a senior citizen O
Cheque or Money
Orderenclosed for $ (full course fee) payable to Conestoga College.
We do not accept post-dated cheques.
•
Registration is limited to Canadian Citizens and/or landed immigrants unless special permission has been granted by Employment and Immigration
Canada. You may apply for a prorated refund before the end 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. Itis the responsibility of each student to be enrolled In a
Health Insurance Plan or OHIP.
Applicant's Signature: Date*
Note: Applications must be signed and dated.
Form R084
C CAMPUSES
Cambridge Campus
1305• Bishop Street N.
Cambridge, Ontario.
N1 R 6Z2
(519) 623-4898
Doon Campus
299 Doon Valley Dr.
Kitchener, Ontario.
N2G 4M4
.19) 553-7460
Clinton Campus.
Vanastra Rd.
P.O. Box 160
Clinton, Ontario.
NOM 1L0
(519) 482-3458
Stratford Campus
270 Water Street
P.O. Box 848
Stratford, Ontario.
N5A 6W3
(519) 271-5700
Guelph Campus
460 Speedvale Ave. W.
Guelph, Ontario.
N1H 6N6
(519) 824-9390
Waterloo Campus
435 King Street N. .,
Waterloo, Ontario.
N2J 2Z5
(519) 885-0300
If there is a' mail interruption please take your Application/Registration Form to the campus offering the. course
REGISTER EARLY! DON'T BE DISAPPOINTED! CLASS SIZES ARE LIMITED!