Clinton News-Record, 1984-01-04, Page 38Application/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:
NOTE: THIS IS NOT A RECEIPT.
Specify your choice of time slot if
more than one class is advertised on
' the same day
Day: Starts:
Name:
Address:
First Name
Last Name:
Sex: Male ❑
Female 0
Apt. No. No. and Street
Postal Residence
Code: Telephone:
City:
Business
Telephone:.
Employer
Please check one of the following:
-(a) I am under 19 and have successfully completed Grade 12 0 or, m
(b) I am under 19 and nave not successfully completed -Grade 12 ❑ or,
(d) I am over 19tCitizen , but not a senior citizen ge 60 and 0 0
or,
Cheque or Money
Order enclosed for $ (full course. fee) payable to Conestoga College.
We do not accept post-dated cheques. and
•
is
apply for a prorated f tref refund before the end o the third schedulets unless d class. Forecial ission has been additl nal informationed please refer to thetRefund section In
C
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 n a
Health Insurance Plan or OHIP.
Date:
Applicant's Signature:
Note: Applications must be signed and dated.
Form ROM
I CAMPUSES
Cambridge Campus
1305 Bishop, Street N.
Cambridge, Ontario.
N1R 6Z2
(519) 623-4898
Doon Campus
299 Doon Valley Dr.
Kitchener, Ontario.
N2G 4M4
--(5-'r9)-65i-3--746,0!---
If there is a mail interrruption please take your Application/Registration Form 'to the campus offering the course
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
(51 g1 27165700
Guelph Campus
460 Speedvale Ave. W.
Guelph, Ontario.
N1 H 6N6
(519) 824-9390
Waterloo Campus
435 King Street N.
Waterloo, Ontario.
N2J 2Z5
(519) 885-0300
REGISTER EARLY! DON'T BE DISAPPOINTED! CLASS SIZES ARE LIMITED!'